Provider Demographics
NPI:1922468818
Name:STIVER, JUSTIN W (PT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:W
Last Name:STIVER
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 1:20 OVERBROOK DR STE D
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1147
Mailing Address - Country:US
Mailing Address - Phone:513-539-2886
Mailing Address - Fax:877-430-7975
Practice Address - Street 1:1076 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9535
Practice Address - Country:US
Practice Address - Phone:941-918-9575
Practice Address - Fax:877-430-7975
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 31147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist