Provider Demographics
NPI:1972091015
Name:SHIRLEY, AUSTYN PERRY (CMT)
Entity type:Individual
Prefix:
First Name:AUSTYN
Middle Name:PERRY
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W 4TH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3253
Mailing Address - Country:US
Mailing Address - Phone:530-786-5484
Mailing Address - Fax:
Practice Address - Street 1:1281 EAST AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1023
Practice Address - Country:US
Practice Address - Phone:530-786-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62258225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist