Basic Information
| Provider Information | |||||||||
| NPI: | 1154722734 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JUSTICE | ||||||||
| FirstName: | PHILIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 WARRIOR DR | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | STEPHENS CITY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226554076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408689599 | ||||||||
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| Practice Location | |||||||||
| Address1: | 640 WARRIOR DR | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | STEPHENS CITY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226554076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408689599 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2014 | ||||||||
| LastUpdateDate: | 09/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305209076 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.