Provider Demographics
NPI:1679301063
Name:AUGUSTINE, BRIANA (PTA)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:
Other - Last Name:BROWNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:2149 TOPS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-6215
Mailing Address - Country:US
Mailing Address - Phone:251-404-3129
Mailing Address - Fax:
Practice Address - Street 1:157 LEWIS ST
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7699
Practice Address - Country:US
Practice Address - Phone:907-488-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225815225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant