Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 814 | AR |
NPI | 1053560664 |
---|---|
Provider Name | Mrs. Mary K Austin |
First Address | Little Rock, AR 72205-3831 |
Second Address | Little Rock, AR 72202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2008 |
Last Update Date | 12/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116100721 | (05) | AR |