Individual
AUGUST BENJAMIN PRIVRATSKY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, CP
Contact information
Practice address
210 NEWPORT CENTER DR STE 3, NEWPORT BEACH, CA 92660-7505
(760) 277-4034
(949) 719-2600
Mailing address
828 S HAYWARD ST, ANAHEIM, CA 92804-3823
(760) 277-4034
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
—
—
225100000X
Physical Therapist
1079887
TX
225100000X
Physical Therapist
1797
OK
225100000X
Physical Therapist
Primary
29431
CA
225100000X
Physical Therapist
350182-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6147910001
MEDICARE PROSTHETIST, DME SUPPLIER
UT
Enumeration date
02/27/2007
Last updated
12/10/2020
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