Provider Demographics
NPI:1790321669
Name:PETRIE, AUSTIN JAMES (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:JAMES
Last Name:PETRIE
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 1:1328 GLADYS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2512
Mailing Address - Country:US
Mailing Address - Phone:419-276-9081
Mailing Address - Fax:
Practice Address - Street 1:27300 CEDAR RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1110
Practice Address - Country:US
Practice Address - Phone:216-595-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH017015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist