Provider Demographics
NPI:1205315736
Name:THORP, AUSTIN CLAYTON
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:CLAYTON
Last Name:THORP
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 1:5605 BOXELDER TRL
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5426
Mailing Address - Country:US
Mailing Address - Phone:361-227-2677
Mailing Address - Fax:
Practice Address - Street 1:5605 BOXELDER TRL
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5426
Practice Address - Country:US
Practice Address - Phone:361-227-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator