Provider Demographics
NPI:1427494673
Name:GEORGE, JUSTIS (PT)
Entity type:Individual
Prefix:
First Name:JUSTIS
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 ADMIRALTY WAY STE 420
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6617
Mailing Address - Country:US
Mailing Address - Phone:424-526-5151
Mailing Address - Fax:424-835-6475
Practice Address - Street 1:4640 ADMIRALTY WAY STE 420
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6617
Practice Address - Country:US
Practice Address - Phone:424-526-5151
Practice Address - Fax:424-835-6475
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01493300225100000X
CA293147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist