Provider Demographics
NPI:1154368959
Name:AUSTIN MANUAL THERAPY ASSOCIATES, PC
Entity type:Organization
Organization Name:AUSTIN MANUAL THERAPY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, FAAOMPT
Authorized Official - Phone:512-832-9411
Mailing Address - Street 1:3508 FAR WEST BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3080
Mailing Address - Country:US
Mailing Address - Phone:512-832-9411
Mailing Address - Fax:512-832-9401
Practice Address - Street 1:3508 FAR WEST BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3080
Practice Address - Country:US
Practice Address - Phone:512-832-9411
Practice Address - Fax:512-832-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11504712251X0800X
TX11418442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0099KXOtherBCBS OF TX GROUP NUMBER
TX166524201Medicaid
TX00989WMedicare PIN
TX166524201Medicaid