Austin P McCormack

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P160963064 Issued in WA

Practice address

4200 6TH Ave SE
Lacey, WA 98503-1042

Phone

(360) 459-8311

NPI assigned

Jan 19, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Providence Health & Services Washington

  dba Providence SoundHomeCare and Hospice

  • Home Health Agency
  • Lacey, WA
  • NPI 1063415198
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1710748306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 6TH AVE SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031042",
            "telephone_number": "360-459-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 6TH AVE SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031042",
            "telephone_number": "360-459-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "AUSTIN",
        "middle_name": "P",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160963064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William W McClain
• Bethany Ashton McCleary, LMP
• Rakaiah Christine McClelland
• Desirea A McCloud
• Hannah Marie McCloud
• Amanda Michelle McDowell
• Nicole Marie McDowell, RBT
• Marissa McElligott
• Alexa Lee McFadden
• Rylee McGeary

• Physical Therapy Assistant in Lacey, WA
• Providers in Lacey, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.