Provider Demographics
NPI:1750121299
Name:TREADWAY, AUSTIN BLAKE
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:BLAKE
Last Name:TREADWAY
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 1:811 QUARRY ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2233
Mailing Address - Country:US
Mailing Address - Phone:740-706-3492
Mailing Address - Fax:
Practice Address - Street 1:200 PUTNAM ST STE 516
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3010
Practice Address - Country:US
Practice Address - Phone:740-706-3492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist