Healthcare Provider Details

I. General information

NPI: 1518180173
Provider Name (Legal Business Name): CATHERINE MARIE AUGUSTINE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MEDFORD AVE
PATCHOGUE NY
11772-1281
US

IV. Provider business mailing address

131 N SUFFOLK AVE
MASSAPEQUA NY
11758-3427
US

V. Phone/Fax

Practice location:
  • Phone: 631-207-2370
  • Fax:
Mailing address:
  • Phone: 516-729-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27405
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: