Healthcare Provider Details

I. General information

NPI: 1881844611
Provider Name (Legal Business Name): HOLLY J AUGUSTINE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6419 N 85TH PL
SCOTTSDALE AZ
85250-5706
US

IV. Provider business mailing address

6419 N 85TH PL
SCOTTSDALE AZ
85250-5706
US

V. Phone/Fax

Practice location:
  • Phone: 218-791-0122
  • Fax:
Mailing address:
  • Phone: 218-791-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8144
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: