Provider Demographics
NPI:1659608198
Name:ST.JAMES, JUSTIN CHARLES (DPT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:CHARLES
Last Name:ST.JAMES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:320 W GLENEAGLES DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5245
Mailing Address - Country:US
Mailing Address - Phone:602-751-7812
Mailing Address - Fax:602-266-6533
Practice Address - Street 1:539 E GLENDALE AVE
Practice Address - Street 2:STE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4900
Practice Address - Country:US
Practice Address - Phone:602-241-3145
Practice Address - Fax:602-241-3146
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X, 2251X0800X
AZ7847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic