Provider Demographics
NPI:1891948774
Name:JUSTICE, JENNIFER AMANDA (DPT, SCS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AMANDA
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:DPT, SCS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2216 GREEN HERON CT
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8600
Mailing Address - Country:US
Mailing Address - Phone:904-434-5737
Mailing Address - Fax:904-560-5283
Practice Address - Street 1:1525 VIRGILS WAY UNIT 1
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-3780
Practice Address - Country:US
Practice Address - Phone:904-657-0089
Practice Address - Fax:904-560-5283
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT282372251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports