Provider Demographics
NPI:1013528066
Name:WILLIAMS, AUSTIN TYLER (PT, DPT, OCS, CSCS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:TYLER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT, DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 NE WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5806
Mailing Address - Country:US
Mailing Address - Phone:816-944-6825
Mailing Address - Fax:816-548-1024
Practice Address - Street 1:1629 NE WESTWIND DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5806
Practice Address - Country:US
Practice Address - Phone:816-944-6825
Practice Address - Fax:816-548-1024
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019021047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist