Provider Demographics
NPI:1497153241
Name:HANDWERGER-HOLK, JUSTINE (PT)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:HANDWERGER-HOLK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-8602
Mailing Address - Country:US
Mailing Address - Phone:714-957-6889
Mailing Address - Fax:714-564-1689
Practice Address - Street 1:1182 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-8602
Practice Address - Country:US
Practice Address - Phone:714-957-6889
Practice Address - Fax:714-546-8616
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist