MEDICARE: TODD M JUSTAK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05007788A	IN
2	225100000X	Physical Therapist	006561	KY

General Provider Information

NPI Number	:	1033599550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD M JUSTAK PT

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	9300 STONESTREET RD
Second Line	:	SUITE 400
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-2863
Country	:	US
Telephone Number	:	502-935-9776
Fax Number	:	502-935-9813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	07/09/2016

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Directions to “ TODD M JUSTAK PT” Practice Location

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