Provider Demographics
NPI:1508935784
Name:CHEESMAN, JUSTIN R (DPT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:R
Last Name:CHEESMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:38 SHERIDAN PARK CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7022
Mailing Address - Country:US
Mailing Address - Phone:843-815-5628
Mailing Address - Fax:843-815-5637
Practice Address - Street 1:3001 BRIDGEBORO RD
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-9700
Practice Address - Country:US
Practice Address - Phone:856-368-2551
Practice Address - Fax:856-210-7110
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA01394400225100000X
SC7816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist