Provider Demographics
NPI:1144707381
Name:ABRAHAM, AUSTIN KARATHURUTHEL (PTA)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:KARATHURUTHEL
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5682
Mailing Address - Country:US
Mailing Address - Phone:813-662-1366
Mailing Address - Fax:813-662-1159
Practice Address - Street 1:3248 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5682
Practice Address - Country:US
Practice Address - Phone:813-662-1366
Practice Address - Fax:813-662-1159
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28631225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant