Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT0000005211 | TN |
NPI | 1467444547 |
---|---|
Provider Name | Mark Nolan Augustine |
First Address | Norfolk, VA 23518-2814 |
Second Address | Norfolk, VA 23507-1904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 19/05/2008 |