Provider Demographics
NPI:1245630540
Name:BADER, JUSTIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:BADER
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 1:569 LENAPE CT
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4135
Mailing Address - Country:US
Mailing Address - Phone:914-447-1956
Mailing Address - Fax:
Practice Address - Street 1:5848 SNYDER DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9497
Practice Address - Country:US
Practice Address - Phone:716-433-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037446225100000X
FLPT38586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist