Provider Demographics
NPI:1104486513
Name:AUSTIN, CLAYTON MITCHELL (DPT)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:MITCHELL
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 VETERANS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-4930
Mailing Address - Country:US
Mailing Address - Phone:256-764-9304
Mailing Address - Fax:256-764-9343
Practice Address - Street 1:1751 VETERANS DR STE 300
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4930
Practice Address - Country:US
Practice Address - Phone:256-764-9304
Practice Address - Fax:256-764-9343
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL260497Medicaid