Provider Demographics
NPI:1689688194
Name:AUSTIN, ALICIA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4000 N SCOTTSDALE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4500
Mailing Address - Country:US
Mailing Address - Phone:480-361-1841
Mailing Address - Fax:480-361-1689
Practice Address - Street 1:3200 E CAMELBACK RD
Practice Address - Street 2:SUITE 135
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2311
Practice Address - Country:US
Practice Address - Phone:602-954-9473
Practice Address - Fax:602-954-8494
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104456Medicare PIN