Austin Tyler Gore
Individual provider Active NPI Physical Therapy Assistant · Saint Clair, MI
NPI 1669395166 · NPPES record last updated Aug 1, 2026
Key facts
- NPI
- 1669395166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 5502006176 (MI)
- Practice address
- 1206 Cedar St
Saint Clair, MI 48079-4950 - Phone
- (810) 289-9317
- NPI assigned
- Aug 1, 2026
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5502006176 | MI | Yes |
Addresses
Primary practice location
1206 Cedar St
Saint Clair, MI 48079-4950
Mailing address
1206 Cedar St
Saint Clair, MI 48079-4950
Phone (810) 289-9317
Other providers in Saint Clair, MI
- George L Friederichs
- Lucas Fulton
- Karishma Gandhi
- George L Friederichs DDS
- Dianna Lyn Gill
- Kerryn Josephine Graham
- Susan M Grewe
- H2G Dental PLLC
- Rene Marie Hall
- Thomas M Hanrahan
All providers in Saint Clair, MI · Physical Therapy Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.