Provider Demographics
NPI:1396453809
Name:PINARDO, AUSTIN (DPT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:PINARDO
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 1:514 BECKLEY CROSSING SHPG CTR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-7110
Mailing Address - Country:US
Mailing Address - Phone:304-250-0428
Mailing Address - Fax:
Practice Address - Street 1:514 BECKLEY CROSSING SHPG CTR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-7110
Practice Address - Country:US
Practice Address - Phone:304-250-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty