Provider Demographics
NPI:1659045326
Name:PEARSON, AUSTIN BLAKE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:BLAKE
Last Name:PEARSON
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 1:1177 ANNANDALE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-8311
Mailing Address - Country:US
Mailing Address - Phone:706-968-0479
Mailing Address - Fax:
Practice Address - Street 1:4754 MARTIN RD # 200
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3507
Practice Address - Country:US
Practice Address - Phone:770-967-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist