Provider Demographics
NPI:1194752816
Name:SIMPSON, JUSTIN MONTORO (ATC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MONTORO
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CHERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29130-8367
Mailing Address - Country:US
Mailing Address - Phone:803-337-2706
Mailing Address - Fax:
Practice Address - Street 1:836 US HIGHWAY 321 BYP S
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-6725
Practice Address - Country:US
Practice Address - Phone:803-635-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer