Provider Demographics
NPI:1124709902
Name:YODER, AUSTIN TYLER (DPT, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:TYLER
Last Name:YODER
Suffix:
Gender:M
Credentials:DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 WAGNER DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-1320
Mailing Address - Country:US
Mailing Address - Phone:812-787-1168
Mailing Address - Fax:
Practice Address - Street 1:300 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-1708
Practice Address - Country:US
Practice Address - Phone:812-709-3286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2025-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05016151A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist