Provider Demographics
NPI:1255923041
Name:EMERSON, JUSTIN EITAL (PT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:EITAL
Last Name:EMERSON
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 1:1818 S UNION AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1953
Mailing Address - Country:US
Mailing Address - Phone:253-627-7012
Mailing Address - Fax:253-627-7014
Practice Address - Street 1:1818 S UNION AVE STE 1B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1953
Practice Address - Country:US
Practice Address - Phone:253-627-7012
Practice Address - Fax:253-627-7014
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61129630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist