Provider Demographics
NPI:1891763538
Name:AUGUSTINE, AMBER J (DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:J
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:JEAN
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1555 SE DELAWARE AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021
Mailing Address - Country:US
Mailing Address - Phone:515-963-8723
Mailing Address - Fax:515-963-8755
Practice Address - Street 1:5921 SE 14TH ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1746
Practice Address - Country:US
Practice Address - Phone:515-953-0024
Practice Address - Fax:515-953-0257
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665430Medicaid
IA0665737Medicaid
IA39071OtherWELLMARK BCBS
IA0665430Medicaid
IAI19172072Medicare PIN
IAIB3481Medicare PIN
IAIB3481020Medicare PIN
IA0665737Medicaid
IAIB1213Medicare PIN
IAI19172Medicare PIN
IAIB1212Medicare PIN