Provider Demographics
NPI:1790713873
Name:AUSTIN, MARY JOHNSTON (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOHNSTON
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9 ROCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:NY
Mailing Address - Zip Code:12776-5307
Mailing Address - Country:US
Mailing Address - Phone:607-498-5653
Mailing Address - Fax:
Practice Address - Street 1:9 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:NY
Practice Address - Zip Code:12776-5307
Practice Address - Country:US
Practice Address - Phone:607-498-5653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0050371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQK7261Medicare ID - Type UnspecifiedPHYSICAL THERAPIST