Provider Demographics
NPI:1114600251
Name:MARLEY, JUSTIN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MARLEY
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 N MOORE RD
Mailing Address - Street 2:
Mailing Address - City:ROBBINS
Mailing Address - State:NC
Mailing Address - Zip Code:27325-8259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1504 NORTH MOORE RD
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:NC
Practice Address - Zip Code:27325
Practice Address - Country:US
Practice Address - Phone:910-464-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-29022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer