Provider Demographics
NPI:1093511693
Name:HARVEY, JUSTIN (DPT, PT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HARVEY
Suffix:
Gender:
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HAWTHORNE LN UNIT 109
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-0002
Mailing Address - Country:US
Mailing Address - Phone:239-822-4324
Mailing Address - Fax:
Practice Address - Street 1:6842 CARNEGIE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3547
Practice Address - Country:US
Practice Address - Phone:704-803-8038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP238582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty