Provider Demographics
NPI:1841774114
Name:PADUA, AUSTIN VINCENT (DPT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:VINCENT
Last Name:PADUA
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 1:34 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2018
Mailing Address - Country:US
Mailing Address - Phone:516-263-0422
Mailing Address - Fax:
Practice Address - Street 1:34 CHERRY ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2018
Practice Address - Country:US
Practice Address - Phone:516-263-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043469-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist