Provider Demographics
NPI:1952658312
Name:HAMPTON, JUSTYN LEE (LMT)
Entity Type:Individual
Prefix:
First Name:JUSTYN
Middle Name:LEE
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 LOCKHAVEN DR NE APT D
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3760
Mailing Address - Country:US
Mailing Address - Phone:503-507-8927
Mailing Address - Fax:
Practice Address - Street 1:7180 SW HAZELFERN RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7762
Practice Address - Country:US
Practice Address - Phone:503-772-3297
Practice Address - Fax:503-496-0835
Is Sole Proprietor?:No
Enumeration Date:2012-08-04
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18893225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist