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General NPI Number Information
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NPI Number | 1003522079
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Entity Type | Individual
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Provider Name | AUGUSTUS JOSEPH WOESTMAN PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 4 DOUGLAS RD
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City | ELLISVILLE
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State | MS
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Zip | 39437-4805
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Country | US
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Telephone | 619-733-4593
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Fax |
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Provider Business Mailing Address
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Address Line | 4 DOUGLAS RD
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City | ELLISVILLE
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State | MS
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Zip | 39437-4805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 299456
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT7054
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License Number State | MS
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