Provider Demographics
NPI:1508938051
Name:JUSTISS, SYLVIA ANN (PTA)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:ANN
Last Name:JUSTISS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12821 W LLANO DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-6527
Mailing Address - Country:US
Mailing Address - Phone:623-535-4829
Mailing Address - Fax:
Practice Address - Street 1:16140 N ARROWHEAD FOUNTAIN CENTER DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-572-6776
Practice Address - Fax:623-572-6962
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0238A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036551Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER