Active NPI
Ma Gina D Augusto
- Physical Therapist
- Antioch, IL
National Provider Identifier
1164595872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 1010 Sanderling CT
Antioch, IL 60002-6414 - Phone
- (847) 395-7973
- Fax
- (847) 395-7973
- NPI assigned
- Nov 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | IL | Primary |
Addresses
Primary practice location
1010 Sanderling CT
Antioch, IL 60002-6414
Mailing address
1010 Sanderling CT
Antioch, IL 60002-6414
Phone (847) 395-7973
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070012211 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184716800000",
"number": "1164595872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 SANDERLING CT",
"city": "ANTIOCH",
"state": "IL",
"postal_code": "600026414",
"telephone_number": "847-395-7973",
"fax_number": "847-395-7973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 SANDERLING CT",
"city": "ANTIOCH",
"state": "IL",
"postal_code": "600026414",
"telephone_number": "847-395-7973",
"fax_number": "847-395-7973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AUGUSTO",
"first_name": "MA GINA",
"middle_name": "D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-17",
"last_updated": "2007-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.