MEDICARE: MRS. HEATHER WOODS AGUSTINES P.T.

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	928	AK
2	225100000X	Physical Therapist	PT20087	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417935792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER WOODS AGUSTINES P.T.

Provider Business Mailing Address
First Line	:	167 S SANTA CLAUS LN STE B
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-7755
Country	:	US
Telephone Number	:	907-488-4978
Fax Number	:	907-488-4976

Provider Business Practice Location Address
First Line	:	167 S SANTA CLAUS LN
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-7755
Country	:	US
Telephone Number	:	907-488-4978
Fax Number	:	907-488-4976

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	02/13/2008

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