Provider Demographics
NPI:1992435655
Name:AUSTIN, MICHAEL (ATC, CFSC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:ATC, CFSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 E SAYLES DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-7145
Mailing Address - Country:US
Mailing Address - Phone:847-903-7254
Mailing Address - Fax:
Practice Address - Street 1:2901 CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-2536
Practice Address - Country:US
Practice Address - Phone:847-718-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0029502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer