Provider Demographics
NPI:1881366102
Name:AUSTIN, EDEN KIRSTEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:KIRSTEN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13913 COURTLAND LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6939
Mailing Address - Country:US
Mailing Address - Phone:301-821-6068
Mailing Address - Fax:
Practice Address - Street 1:1117 YARD ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:43212-3930
Practice Address - Country:US
Practice Address - Phone:614-591-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28488225100000X
DCPT872763225100000X
VACP014616T225100000X
OHCP014659T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist