Provider Demographics
NPI:1811357338
Name:CHUCK, JUSTIN (DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:CHUCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:550 MOUNTAIN CREST RD
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1513
Mailing Address - Country:US
Mailing Address - Phone:626-400-9524
Mailing Address - Fax:626-355-1628
Practice Address - Street 1:1021 E WALNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1478
Practice Address - Country:US
Practice Address - Phone:626-400-9524
Practice Address - Fax:626-355-1628
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist