Provider Demographics
NPI:1720415771
Name:SELIGMAN, JUSTIN WALTER (ATC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WALTER
Last Name:SELIGMAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SPOTSWOOD AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1200
Mailing Address - Country:US
Mailing Address - Phone:540-454-8124
Mailing Address - Fax:
Practice Address - Street 1:14171 TURNER DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-6675
Practice Address - Country:US
Practice Address - Phone:540-454-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-06
Last Update Date:2013-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260017042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer