Provider Demographics
NPI:1841500022
Name:SUDLOW, JUSTIN CRAIG (DPT)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:CRAIG
Last Name:SUDLOW
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:9216 ARDREY KELL RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4954
Practice Address - Country:US
Practice Address - Phone:980-556-7330
Practice Address - Fax:980-939-8215
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01377700225100000X, 2251X0800X
NCP100106E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic