Provider Demographics
NPI:1588858179
Name:LLAMAS, JUSTIN L (PT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:L
Last Name:LLAMAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 NW MODA WAY
Mailing Address - Street 2:APT 816
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7024
Mailing Address - Country:US
Mailing Address - Phone:708-589-5377
Mailing Address - Fax:
Practice Address - Street 1:10126 SW PARK WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5008
Practice Address - Country:US
Practice Address - Phone:503-215-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008375A225100000X
IL070019472225100000X
OR06867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist