Provider Demographics
NPI:1417325028
Name:STEIN, JUSTIN
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:STEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MAKAWAO AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8859
Mailing Address - Country:US
Mailing Address - Phone:808-572-2281
Mailing Address - Fax:808-573-5869
Practice Address - Street 1:402 E GREENWAY PKWY
Practice Address - Street 2:#12
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2350
Practice Address - Country:US
Practice Address - Phone:602-789-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist