Provider Demographics
NPI:1629738141
Name:JUSTICE, AMELIA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 OVERSEER RETREAT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2735
Mailing Address - Country:US
Mailing Address - Phone:336-529-4686
Mailing Address - Fax:
Practice Address - Street 1:580 ROBERT DANIEL DR
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7448
Practice Address - Country:US
Practice Address - Phone:437-652-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics