Provider Demographics
NPI:1952478273
Name:AUGUST, ROBERTA (PT)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:AUGUST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ROBERTA
Other - Middle Name:AUGUST
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10100 SE SUNNYSIDE RD
Mailing Address - Street 2:KAISER MT. TALBERT PHYSICAL THERAPY DEPARTMENT
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10100 SE SUNNYSIDE RD
Practice Address - Street 2:KAISER MT. TALBERT PHYSICAL THERAPY DEPARTMENT
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-571-8180
Practice Address - Fax:503-571-8183
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9280225100000X
OR1172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist