Active NPI
Elizabeth Mable Augustine, DPT
- Physical Therapist
- Green Valley, AZ
National Provider Identifier
1679741094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6420
- Practice address
- 101 S la Canada Dr # 47
Green Valley, AZ 85614-2603 - Phone
- (520) 207-9345
- Fax
- (520) 207-9345
- NPI assigned
- Feb 19, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 6420 | AZ | Primary |
Addresses
Primary practice location
101 S la Canada Dr # 47
Green Valley, AZ 85614-2603
Mailing address
307 N Calle del Chancero
Green Valley, AZ 85614-3019
Phone (520) 574-2364
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z 104140 | Other | AZ | GROUP LEGACY |
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 |
|---|---|---|---|
| 6420 | AZ | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Empower Physical Therapy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Medicine & Rehabilitation Physician
- Green Valley, AZ
- NPI 1538192216
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203379200000",
"number": "1679741094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 N CALLE DEL CHANCERO",
"city": "GREEN VALLEY",
"state": "AZ",
"postal_code": "856143019",
"telephone_number": "520-574-2364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 S LA CANADA DR # 47",
"city": "GREEN VALLEY",
"state": "AZ",
"postal_code": "856142603",
"telephone_number": "520-207-9345",
"fax_number": "520-207-9345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AUGUSTINE",
"first_name": "ELIZABETH",
"middle_name": "MABLE",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-19",
"last_updated": "2008-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "6420",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP LEGACY",
"identifier": "Z 104140",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Valley, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.