Provider Demographics
NPI:1770140899
Name:BATTLE, JUSTIN LEE (PTA)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:BATTLE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 WEBSTER ST APT 2301
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8681
Mailing Address - Country:US
Mailing Address - Phone:281-731-2158
Mailing Address - Fax:
Practice Address - Street 1:14825 NORTHWEST FWY STE 800
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-4081
Practice Address - Country:US
Practice Address - Phone:281-890-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2146081225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant