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General NPI Number Information
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NPI Number | 1346233863
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Entity Type | Individual
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Provider Name | CHRISTIE KENNEDY AUGUSTINE MPT
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Gender | Female
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 308 BRYNN MARR RD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7023
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Country | US
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Telephone | 910-478-9701
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Fax |
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Provider Business Mailing Address
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Address Line | HC 6 BOX 6046
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City | HAWLEY
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State | PA
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Zip | 18428-9100
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Country | US
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Telephone | 570-226-5680
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Fax | 570-226-5682
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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 | P19468
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License Number State | NC
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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 | PT008630L
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License Number State | PA
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