Provider Demographics
NPI:1346233863
Name:AUGUSTINE, CHRISTIE KENNEDY (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:KENNEDY
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:ANNE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:HC 6 BOX 6046
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-9100
Mailing Address - Country:US
Mailing Address - Phone:570-226-5680
Mailing Address - Fax:570-226-5682
Practice Address - Street 1:308 BRYNN MARR RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7023
Practice Address - Country:US
Practice Address - Phone:910-478-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19468225100000X
PAPT008630L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
819229Other1ST PRIO-NOLIMITS
AU1693421OtherBLUE SHIELD
PT00863OLOtherLIC #
842948OtherMPN
9373970OtherPHCS
819136Other1ST PRIO-MOTION
088956Medicare ID - Type Unspecified