Provider Demographics
NPI:1922235100
Name:AGUSTIN, ADRIAN NEIL (PT)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:NEIL
Last Name:AGUSTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SUNSET HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-2165
Mailing Address - Country:US
Mailing Address - Phone:660-385-1625
Mailing Address - Fax:660-385-1625
Practice Address - Street 1:701 SUNSET HILLS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2165
Practice Address - Country:US
Practice Address - Phone:660-385-1625
Practice Address - Fax:660-385-1625
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist