Provider Demographics
NPI:1114451655
Name:AUGUSTE, ROBERTSON (PT,DPT)
Entity Type:Individual
Prefix:
First Name:ROBERTSON
Middle Name:
Last Name:AUGUSTE
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SW 84TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2754
Mailing Address - Country:US
Mailing Address - Phone:954-720-1530
Mailing Address - Fax:
Practice Address - Street 1:220 SW 84TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2754
Practice Address - Country:US
Practice Address - Phone:954-720-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT315282081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine