Provider Demographics
NPI:1396840534
Name:JUSTIZ, JANICE R (PT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:R
Last Name:JUSTIZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2338 IMMOKALEE RD STE 187
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1445
Mailing Address - Country:US
Mailing Address - Phone:239-571-7309
Mailing Address - Fax:239-566-3735
Practice Address - Street 1:2338 IMMOKALEE RD STE 187
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1445
Practice Address - Country:US
Practice Address - Phone:239-571-7309
Practice Address - Fax:239-566-3735
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT6693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886280000Medicaid