Provider Demographics
NPI:1013268572
Name:SLAUGHTER, JUSTIN DESHAUN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DESHAUN
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 FISH POND RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2581
Mailing Address - Country:US
Mailing Address - Phone:254-741-8450
Mailing Address - Fax:
Practice Address - Street 1:6600 FISH POND RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2581
Practice Address - Country:US
Practice Address - Phone:254-741-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1222190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist