Provider Demographics
NPI:1972216968
Name:JGPT LLC
Entity type:Organization
Organization Name:JGPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RADA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:313-580-7525
Mailing Address - Street 1:1025 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6932
Mailing Address - Country:US
Mailing Address - Phone:313-580-7525
Mailing Address - Fax:
Practice Address - Street 1:1025 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6932
Practice Address - Country:US
Practice Address - Phone:313-580-7525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy