Provider Demographics
NPI:1023494820
Name:MUELLER, AUSTIN DWAINE (ATC)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DWAINE
Last Name:MUELLER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:SD
Mailing Address - Zip Code:57003-2063
Mailing Address - Country:US
Mailing Address - Phone:605-370-8582
Mailing Address - Fax:
Practice Address - Street 1:2215 W PENTAGON PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57107-1104
Practice Address - Country:US
Practice Address - Phone:605-312-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
SD05002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer