Provider Demographics
NPI:1790924876
Name:PYE, JUSTIN GARRETT (PT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GARRETT
Last Name:PYE
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 1:2003 ALICE ST STE A
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6209
Mailing Address - Country:US
Mailing Address - Phone:912-285-0053
Mailing Address - Fax:912-283-9289
Practice Address - Street 1:1251 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-7729
Practice Address - Country:US
Practice Address - Phone:912-559-2071
Practice Address - Fax:912-559-2143
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I650962Medicare PIN