Provider Demographics
NPI:1760894273
Name:FAIR, AUSTIN MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:MICHAEL
Last Name:FAIR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E RIGGS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5403
Mailing Address - Country:US
Mailing Address - Phone:480-802-8730
Mailing Address - Fax:480-802-8739
Practice Address - Street 1:950 E RIGGS RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5403
Practice Address - Country:US
Practice Address - Phone:480-802-8730
Practice Address - Fax:480-802-8739
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10935PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist