Provider Demographics
NPI:1689259590
Name:HESCHONG-NIPPERT, AUSTIN (DPT)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:HESCHONG-NIPPERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4808
Mailing Address - Country:US
Mailing Address - Phone:916-474-0369
Mailing Address - Fax:
Practice Address - Street 1:1836 HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-4808
Practice Address - Country:US
Practice Address - Phone:916-474-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist