Provider Demographics
NPI:1063089910
Name:JUSTYN, JOHN SAMUEL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SAMUEL
Last Name:JUSTYN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6851 S HOLLY CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1050
Mailing Address - Country:US
Mailing Address - Phone:720-644-0181
Mailing Address - Fax:720-381-6868
Practice Address - Street 1:6851 S HOLLY CIR STE 110
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1050
Practice Address - Country:US
Practice Address - Phone:720-644-0181
Practice Address - Fax:720-381-6868
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20503208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP20503OtherSTATE LICENSE