Provider Demographics
NPI:1144455809
Name:AGUSTIN, NEIL ANTHONY QUIBILAN (PT)
Entity type:Individual
Prefix:
First Name:NEIL ANTHONY
Middle Name:QUIBILAN
Last Name:AGUSTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 NORTHPOINTE CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6648
Mailing Address - Country:US
Mailing Address - Phone:850-474-0189
Mailing Address - Fax:
Practice Address - Street 1:4643 NORTHPOINTE CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6648
Practice Address - Country:US
Practice Address - Phone:850-474-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist