Provider Demographics
NPI:1285220632
Name:JADUNANDAN, JUSTIN (DPT, ATC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:JADUNANDAN
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 TREEMONT AVE SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-3536
Mailing Address - Country:US
Mailing Address - Phone:321-216-7236
Mailing Address - Fax:
Practice Address - Street 1:470 MALABAR RD SE UNIT 102
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3124
Practice Address - Country:US
Practice Address - Phone:321-802-9645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist