Provider Demographics
NPI:1033694567
Name:PHILIP, JUSTINA ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:ELIZABETH
Last Name:PHILIP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JUSTINA
Other - Middle Name:ELIZABETH
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2348 SHOREHAM CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5591
Mailing Address - Country:US
Mailing Address - Phone:847-912-5177
Mailing Address - Fax:
Practice Address - Street 1:2318 SAN JACINTO BLVD STE 108
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7535
Practice Address - Country:US
Practice Address - Phone:940-380-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1311570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist