Provider Demographics
NPI:1568034734
Name:WEBB, JUSTIN SIMMS (DPT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SIMMS
Last Name:WEBB
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4324 S SHERWOOD FOREST BLVD STE B170
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4481
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-465-8823
Practice Address - Street 1:10161 FLORIDA BLVD
Practice Address - Street 2:STE B
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-6049
Practice Address - Country:US
Practice Address - Phone:225-271-8056
Practice Address - Fax:225-271-8057
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
LA10933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist