Provider Demographics
NPI:1235251257
Name:JUSTADO, ANTONIO JR
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:JUSTADO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 37TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6567
Mailing Address - Country:US
Mailing Address - Phone:772-213-9800
Mailing Address - Fax:772-213-9813
Practice Address - Street 1:1260 37TH ST STE 102
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6567
Practice Address - Country:US
Practice Address - Phone:772-213-9800
Practice Address - Fax:772-213-9813
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0008816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG616ZMedicare PIN