Provider Demographics
NPI:1134282718
Name:AUSTIN, GARY P (PT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3339
Mailing Address - Country:US
Mailing Address - Phone:860-979-1600
Mailing Address - Fax:203-866-3014
Practice Address - Street 1:5151 PARK AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1023
Practice Address - Country:US
Practice Address - Phone:203-396-8181
Practice Address - Fax:203-396-8137
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT003804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650000297Medicare ID - Type Unspecified