Provider Demographics
NPI:1336585298
Name:LIEB, JUSTINE ELLEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:ELLEN
Last Name:LIEB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 PORT WATSON ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2823
Mailing Address - Country:US
Mailing Address - Phone:607-758-7212
Mailing Address - Fax:607-758-3416
Practice Address - Street 1:134 HOMER AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1206
Practice Address - Country:US
Practice Address - Phone:607-753-0000
Practice Address - Fax:607-753-6073
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist