Provider Demographics
NPI:1194082073
Name:STREEFKERK, JUSTIN BLAKE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BLAKE
Last Name:STREEFKERK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 KING RD
Mailing Address - Street 2:STE B
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7909
Mailing Address - Country:US
Mailing Address - Phone:586-531-5825
Mailing Address - Fax:
Practice Address - Street 1:14700 KING RD
Practice Address - Street 2:STE B
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7909
Practice Address - Country:US
Practice Address - Phone:734-288-0235
Practice Address - Fax:734-288-0236
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist