Provider Demographics
NPI:1740465566
Name:JUSTICE, ALAN S (PT)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:877 3RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-1827
Mailing Address - Country:US
Mailing Address - Phone:850-638-8447
Mailing Address - Fax:850-638-9217
Practice Address - Street 1:877 3RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1827
Practice Address - Country:US
Practice Address - Phone:850-638-8447
Practice Address - Fax:850-638-9217
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT 14282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist