Provider Demographics
NPI:1245631506
Name:SMITHERS, AUSTIN WALKER (PT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:WALKER
Last Name:SMITHERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 C T SWITZER SR DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4536
Mailing Address - Country:US
Mailing Address - Phone:228-575-2796
Mailing Address - Fax:
Practice Address - Street 1:2781 C T SWITZER SR DR
Practice Address - Street 2:SUITE 404
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4536
Practice Address - Country:US
Practice Address - Phone:228-575-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist