Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | ||
N | 225100000X | Physical Therapist | 1079887 | TX |
N | 225100000X | Physical Therapist | 1797 | OK |
Y | 225100000X | Physical Therapist | 29431 | CA |
N | 225100000X | Physical Therapist | 350182-2401 | UT |
NPI | 1467589358 |
---|---|
Provider Name | August Benjamin Privratsky JR. |
First Address | Anaheim, CA 92804-3823 |
Second Address | Newport Beach, CA 92660-7505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 10/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000065749 | (02) | |
6147910001 | MEDICARE PROSTHETIST, DME SUPPLIER (01) | UT |