Provider Demographics
NPI:1245610047
Name:BATES, JUSTIN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:BATES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04969-3143
Mailing Address - Country:US
Mailing Address - Phone:207-717-6357
Mailing Address - Fax:
Practice Address - Street 1:407 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04969-3143
Practice Address - Country:US
Practice Address - Phone:207-717-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist