Provider Demographics
NPI:1689057861
Name:TATMAN, JUSTIN ANDREW
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ANDREW
Last Name:TATMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 LEVANTE AVE
Mailing Address - Street 2:MAX OROVITZ BUILDING 124
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2416
Mailing Address - Country:US
Mailing Address - Phone:305-284-6727
Mailing Address - Fax:
Practice Address - Street 1:5821 SAN AMARO DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2402
Practice Address - Country:US
Practice Address - Phone:305-284-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 40202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer