Provider Demographics
NPI:1285702670
Name:AUSTIN, DANA W (PT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:W
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:MT
Mailing Address - Zip Code:59872
Mailing Address - Country:US
Mailing Address - Phone:406-822-4771
Mailing Address - Fax:
Practice Address - Street 1:406 2ND AVENUE EAST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872
Practice Address - Country:US
Practice Address - Phone:406-822-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000340595Medicaid
MT000005839Medicare PIN