Provider Demographics
NPI:1831776848
Name:MACHADO, JUSTIN LUIS (DPT)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LUIS
Last Name:MACHADO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 SABLE PINE CIR APT 950D2
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-2798
Mailing Address - Country:US
Mailing Address - Phone:786-348-1602
Mailing Address - Fax:
Practice Address - Street 1:4751 SABLE PINE CIR APT 950D2
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-2798
Practice Address - Country:US
Practice Address - Phone:786-348-1602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist