Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 026083 | NY |
NPI | 1003044736 |
---|---|
Provider Name | Abigail Marie E Agustero |
First Address | Forest Hills, NY 11375-5501 |
Second Address | Forest Hills, NY 11375-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 01/07/2009 |