Provider Demographics
NPI:1992394712
Name:SMITH, AUSTIN J (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:J
Last Name:SMITH
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 1:33615 DREAM ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-8713
Mailing Address - Country:US
Mailing Address - Phone:262-902-4052
Mailing Address - Fax:
Practice Address - Street 1:4700 NORTHGATE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1149
Practice Address - Country:US
Practice Address - Phone:916-929-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist