Provider Demographics
NPI:1952065773
Name:MIETZ, AUSTIN (DPT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:MIETZ
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 1:6777 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-9610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9095 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1967
Practice Address - Country:US
Practice Address - Phone:716-276-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist