Provider Demographics
NPI:1497347595
Name:AUGUSTINE, TAYLOR CORBAE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:CORBAE
Last Name:AUGUSTINE
Suffix:
Gender:F
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 1:4115 SPENCER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3869
Mailing Address - Country:US
Mailing Address - Phone:303-931-6329
Mailing Address - Fax:
Practice Address - Street 1:615 6TH ST SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-4444
Practice Address - Country:US
Practice Address - Phone:701-628-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist