Provider Demographics
NPI:1154325678
Name:SHURLEY, JUSTIN (PT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SHURLEY
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 1:97 HEFNER ST
Mailing Address - Street 2:STE 100
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-8260
Mailing Address - Country:US
Mailing Address - Phone:706-635-1440
Mailing Address - Fax:
Practice Address - Street 1:97 HEFNER ST
Practice Address - Street 2:STE 100
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8260
Practice Address - Country:US
Practice Address - Phone:706-635-1440
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCLTMedicare ID - Type Unspecified