Provider Demographics
NPI:1942437298
Name:AUGUST, ANITA (PT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:AUGUST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NW 8TH AVE APT 707
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3560
Mailing Address - Country:US
Mailing Address - Phone:503-464-9395
Mailing Address - Fax:503-464-9396
Practice Address - Street 1:300 NW 8TH AVE APT 707
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3560
Practice Address - Country:US
Practice Address - Phone:503-464-9395
Practice Address - Fax:503-464-9396
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-14
Last Update Date:2009-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3376314000000X
ORPT 3376320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities