Provider Demographics
NPI:1053560664
Name:AUSTIN, MARY K (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PT
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Other - First Name:
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Mailing Address - Street 1:304 N PALM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3831
Mailing Address - Country:US
Mailing Address - Phone:501-664-3199
Mailing Address - Fax:
Practice Address - Street 1:1600 RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202
Practice Address - Country:US
Practice Address - Phone:501-663-6965
Practice Address - Fax:501-603-0675
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8142251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116100721Medicaid