Provider Demographics
NPI:1548684830
Name:AUSTIN, REBECCA (AT, ATC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BARTEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6525 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3006
Mailing Address - Country:US
Mailing Address - Phone:313-972-4196
Mailing Address - Fax:
Practice Address - Street 1:26935 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033
Practice Address - Country:US
Practice Address - Phone:947-522-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MI2601001242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No174H00000XOther Service ProvidersHealth Educator