Provider Demographics
NPI:1699071274
Name:AUSTIN, KRISTOPHER KARL (LMP)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:KARL
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:LMP
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 967
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-0967
Mailing Address - Country:US
Mailing Address - Phone:509-674-0908
Mailing Address - Fax:509-672-0920
Practice Address - Street 1:112 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1131
Practice Address - Country:US
Practice Address - Phone:509-674-0908
Practice Address - Fax:509-674-0920
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60193817225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist