Basic Information
Provider Information
NPI: 1972121697
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AUSTIN
FirstName: STEPHANIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9101 WESLEYAN RD STE 100
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462683103
CountryCode: US
TelephoneNumber: 8006036046
FaxNumber: 3178843388
Practice Location
Address1: 870 OAK MEADOW DR
Address2:  
City: FRANKLIN
State: TN
PostalCode: 370645607
CountryCode: US
TelephoneNumber: 6157215439
FaxNumber: 3178843388
Other Information
ProviderEnumerationDate: 07/09/2020
LastUpdateDate: 07/09/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/09/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X6316TNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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