Provider Demographics
NPI:1063298461
Name:MA, JUSTIN STUART GEE MING (DPT, PT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:STUART GEE MING
Last Name:MA
Suffix:
Gender:M
Credentials:DPT, PT
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Mailing Address - Street 1:3085 PRESCOTT FALLS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-5841
Mailing Address - Country:US
Mailing Address - Phone:904-223-0872
Mailing Address - Fax:
Practice Address - Street 1:6 FAIRFIELD BLVD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4627
Practice Address - Country:US
Practice Address - Phone:904-996-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT40605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist