Provider Demographics
NPI:1891239042
Name:SAMPSON, JUSTIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:M
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 1:1372 ROUTE 9
Mailing Address - Street 2:BUILDING #2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4038
Mailing Address - Country:US
Mailing Address - Phone:732-240-9296
Mailing Address - Fax:732-240-9297
Practice Address - Street 1:1372 ROUTE 9
Practice Address - Street 2:BUILDING #2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4038
Practice Address - Country:US
Practice Address - Phone:732-240-9296
Practice Address - Fax:732-240-9297
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01707400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist