Justin Joseph Agustini, LAT
Individual provider Active NPI Athletic Trainer · Hazle Township, PA
NPI 1043640972 · NPPES record last updated Nov 13, 2013
Key facts
- NPI
- 1043640972
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- RTO000178 (PA)
- Practice address
- 1324 N Church St
Hazle Township, PA 18202-9307 - Phone
- (570) 501-1808
- Fax
- (855) 635-6308
- NPI assigned
- Nov 13, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RTO000178 | PA | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | RTO000178 | PA | Yes |
Addresses
Primary practice location
1324 N Church St
Hazle Township, PA 18202-9307
Mailing address
255 Mountain View Dr
Nanticoke, PA 18634-3603
Phone (570) 814-7073
Other providers in Hazle Township, PA
- Dana Marie Addesa
- Ann Andrasovich
- Ara-Hazleton LLC
- Astute Diagnostics LLC
- Joshua Balliet
- Alexis Barker
All providers in Hazle Township, PA · Athletic Trainer in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.