Provider Demographics
NPI:1366892473
Name:AUSTIN, MISTIE L (LMT)
Entity type:Individual
Prefix:
First Name:MISTIE
Middle Name:L
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MISTIE
Other - Middle Name:L
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:11260 OLD SEWARD HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-744-0869
Mailing Address - Fax:907-646-2212
Practice Address - Street 1:11260 OLD SEWARD HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515
Practice Address - Country:US
Practice Address - Phone:907-646-2212
Practice Address - Fax:907-646-2212
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102108225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist