Provider Demographics
NPI:1851411433
Name:AUSTIN, KELLY A (DC, PT)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 W CHANDLER BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5225
Mailing Address - Country:US
Mailing Address - Phone:480-821-1997
Mailing Address - Fax:480-821-1887
Practice Address - Street 1:1076 W CHANDLER BLVD
Practice Address - Street 2:STE 103
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-9662
Practice Address - Country:US
Practice Address - Phone:480-821-1997
Practice Address - Fax:480-821-1887
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5911111NX0800X
AZ4386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26417Medicare UPIN
AZ26416Medicare UPIN