Provider Demographics
NPI:1518346881
Name:JUSTON, KEVIN JAMES (PTA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES
Last Name:JUSTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5255 SNAPFINGER PARK DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4084
Mailing Address - Country:US
Mailing Address - Phone:770-322-7003
Mailing Address - Fax:770-322-7630
Practice Address - Street 1:5255 SNAPFINGER PARK DR
Practice Address - Street 2:SUITE 130
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4084
Practice Address - Country:US
Practice Address - Phone:770-322-7003
Practice Address - Fax:770-322-7630
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPTA003412225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant