Provider Demographics
NPI:1538118377
Name:BOBBY, JUSTIN GEORGE (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:GEORGE
Last Name:BOBBY
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 US 209
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322
Mailing Address - Country:US
Mailing Address - Phone:570-580-0211
Mailing Address - Fax:570-517-0257
Practice Address - Street 1:1830 US 209
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322
Practice Address - Country:US
Practice Address - Phone:570-580-0211
Practice Address - Fax:570-517-0257
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8234225100000X
WVPT004051225100000X
PAPT012277L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist