Provider Demographics
NPI:1992274690
Name:MEYER, JUSTIN WAYNE (PT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WAYNE
Last Name:MEYER
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 1:2806 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3216
Mailing Address - Country:US
Mailing Address - Phone:361-237-1670
Mailing Address - Fax:361-237-1703
Practice Address - Street 1:2806 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3216
Practice Address - Country:US
Practice Address - Phone:361-237-1670
Practice Address - Fax:361-237-1703
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1313322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist