Organization
AUSTIN DIAGNOSTIC CLINIC, PA
Active
Other names
Austin Diagnostic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN M ANDREW (CREDENTIALING SPECIALIST)
(512) 901-4937
Entity
Organization
Contact information
Practice address
12221 MO PAC EXPWY NORTH, DEPT OF PHYSICAL THERAPY, AUSTIN, TX 78758-2483
(512) 901-4402
(512) 901-4103
Mailing address
12221 MO PAC EXPWY NORTH, DEPT OF PHYSICAL THERAPY, AUSTIN, TX 78758-2483
(512) 901-4402
(512) 901-4103
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140347946
—
TX
Enumeration date
02/15/2006
Last updated
10/21/2009
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