Basic Information
| Provider Information | |||||||||
| NPI: | 1417447608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGLE | ||||||||
| FirstName: | JUSTIN | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 DANIELS DR | ||||||||
| Address2: | |||||||||
| City: | CROWLEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760363642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173724743 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5910 N MACARTHUR BLVD STE 133 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750393886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725548494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2018 | ||||||||
| LastUpdateDate: | 05/14/2018 | ||||||||
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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 | 2251X0800X | 1304306 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.