Provider Demographics
NPI:1881082816
Name:WAAS, JUSTIN ROBERT (ATC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ROBERT
Last Name:WAAS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2192 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-3070
Mailing Address - Country:US
Mailing Address - Phone:716-425-7755
Mailing Address - Fax:
Practice Address - Street 1:2192 NORTH AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-3070
Practice Address - Country:US
Practice Address - Phone:716-425-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer