Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 7369 | TN |
NPI | 1003440678 |
---|---|
Provider Name | Zackary Austin |
First Address | Medina, TN 38355-9812 |
Second Address | Humboldt, TN 38343-3070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2020 |
Last Update Date | 23/02/2020 |