Provider Demographics
NPI:1720435068
Name:HOOD, JUSTIN (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:HOOD
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:SD
Mailing Address - Zip Code:57533-1302
Mailing Address - Country:US
Mailing Address - Phone:605-835-5190
Mailing Address - Fax:605-835-5479
Practice Address - Street 1:400 PARK AVE
Practice Address - Street 2:
Practice Address - City:GREGORY
Practice Address - State:SD
Practice Address - Zip Code:57533-1302
Practice Address - Country:US
Practice Address - Phone:605-835-5190
Practice Address - Fax:605-835-5479
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist