Provider Demographics
NPI:1689657397
Name:JUSTUS, DENICE R (MPT)
Entity Type:Individual
Prefix:
First Name:DENICE
Middle Name:R
Last Name:JUSTUS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E REPUBLIC AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5282
Mailing Address - Country:US
Mailing Address - Phone:785-825-1361
Mailing Address - Fax:785-823-7077
Practice Address - Street 1:1101 E REPUBLIC AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5282
Practice Address - Country:US
Practice Address - Phone:785-825-1361
Practice Address - Fax:785-823-7077
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS7454OtherPREFERRED HEALTH SYSTEM
KS203159OtherHEALTH PARTNERS
P00236844OtherR. R. MEDICARE
KS465267OtherCHILDREN'S MERCY
KS100406880BMedicaid
KS100406880BMedicaid
KS140922Medicare ID - Type Unspecified