Provider Demographics
NPI:1275584567
Name:SAMPLEY, JUSTIN M (PT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:SAMPLEY
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 1:425 E PINNACLE PEAK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-5657
Mailing Address - Country:US
Mailing Address - Phone:602-283-3360
Mailing Address - Fax:602-283-3361
Practice Address - Street 1:425 E PINNACLE PEAK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-5657
Practice Address - Country:US
Practice Address - Phone:602-283-3360
Practice Address - Fax:602-283-3361
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80922251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ157377Medicare PIN
AZZ63123Medicare PIN