Provider Demographics
NPI:1154722734
Name:JUSTICE, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 WARRIOR DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-4076
Mailing Address - Country:US
Mailing Address - Phone:540-868-9599
Mailing Address - Fax:
Practice Address - Street 1:640 WARRIOR DR
Practice Address - Street 2:SUITE 115
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-4076
Practice Address - Country:US
Practice Address - Phone:540-868-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist