MEDICARE: LISA J AUGUST PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT9662	OH
2	225100000X	Physical Therapist	11771	NC

General Provider Information

NPI Number	:	1831149038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA J AUGUST PT

Provider Business Mailing Address
First Line	:	3701 NW CARY PKWY
Second Line	:	SUITE 301
City	:	CARY
State	:	NC
Zip	:	27513-8431
Country	:	US
Telephone Number	:	919-388-0111
Fax Number	:	919-388-8668

Provider Business Practice Location Address
First Line	:	3701 NW CARY PKWY
Second Line	:	SUITE 301
City	:	CARY
State	:	NC
Zip	:	27513-8431
Country	:	US
Telephone Number	:	919-388-0111
Fax Number	:	919-388-8668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	01/21/2009

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