Provider Demographics
NPI:1184388381
Name:AUSTIN, ABRAHAM GABRIEL
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:GABRIEL
Last Name:AUSTIN
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 1:1718 CHAPEL TREE CIR APT F
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-9311
Mailing Address - Country:US
Mailing Address - Phone:407-722-1588
Mailing Address - Fax:718-377-5001
Practice Address - Street 1:986 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3005
Practice Address - Country:US
Practice Address - Phone:718-377-5000
Practice Address - Fax:718-377-5001
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31661225200000X
NY010113225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant