Provider Demographics
NPI:1023297454
Name:AUSTRIA, STEPHEN FLORANTE
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FLORANTE
Last Name:AUSTRIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8629
Mailing Address - Country:US
Mailing Address - Phone:541-768-7700
Mailing Address - Fax:541-768-9784
Practice Address - Street 1:14101 FAIRVIEW DR STE 300
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2537
Practice Address - Country:US
Practice Address - Phone:952-892-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61358225100000X
MN8011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist