Provider Demographics
NPI:1013203330
Name:PRETZEL, JUSTIN M (DPT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:PRETZEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:146 MOORESVILLE COMMONS WAY STE 5E
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8938
Practice Address - Country:US
Practice Address - Phone:980-444-0906
Practice Address - Fax:980-444-6812
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871375225100000X
VA2305206940225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192971OtherBCBS (PHYSICAL THERAPY)
VAC05954Medicare PIN