Provider Demographics
NPI:1407513948
Name:KILLORAN, JUSTIN (PTA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:KILLORAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MERIDIAN PL
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-4003
Mailing Address - Country:US
Mailing Address - Phone:609-571-6516
Mailing Address - Fax:
Practice Address - Street 1:100 MERIDIAN PL
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-4003
Practice Address - Country:US
Practice Address - Phone:732-719-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00386200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant