Provider Demographics
NPI:1629851365
Name:GIESE, AUSTIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:GIESE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25460 NORDIC POINT DR
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-3392
Mailing Address - Country:US
Mailing Address - Phone:320-766-2023
Mailing Address - Fax:
Practice Address - Street 1:25460 NORDIC POINT DR
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-3392
Practice Address - Country:US
Practice Address - Phone:320-766-2023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist