Provider Demographics
NPI:1255004024
Name:ENDERLIN, JUSTINE ALIESE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ALIESE
Last Name:ENDERLIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:ALIESE
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:7948 S BLUE CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5424
Mailing Address - Country:US
Mailing Address - Phone:847-305-6401
Mailing Address - Fax:
Practice Address - Street 1:1601 W SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2682
Practice Address - Country:US
Practice Address - Phone:520-872-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-013237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist