Provider Demographics
NPI:1528356664
Name:GUSTIN, EMILY JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:GUSTIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SOUTH SLEEPY CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:CROSS JUNCTION
Mailing Address - State:VA
Mailing Address - Zip Code:22625
Mailing Address - Country:US
Mailing Address - Phone:540-877-0946
Mailing Address - Fax:
Practice Address - Street 1:576 JEFFERSON AVENUE
Practice Address - Street 2:MCDONALD ARMY HEALTH CENTER
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-5548
Practice Address - Country:US
Practice Address - Phone:757-314-7522
Practice Address - Fax:757-314-7524
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist