MEDICARE: JUSTIN JAMES DEPERMENTIER PT, DPT, ATC

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	070.022242	IL
2	225100000X	Physical Therapist	PT024201	PA

General Provider Information

NPI Number	:	1629461868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN JAMES DEPERMENTIER PT, DPT, ATC

Provider Business Mailing Address
First Line	:	450 PARK WAY
Second Line	:	SUITE 300
City	:	BROOMALL
State	:	PA
Zip	:	19008-4202
Country	:	US
Telephone Number	:	484-422-8080
Fax Number	:	484-422-8073

Provider Business Practice Location Address
First Line	:	450 PARK WAY
Second Line	:	SUITE A
City	:	BROOMALL
State	:	PA
Zip	:	19008-4202
Country	:	US
Telephone Number	:	610-355-1780
Fax Number	:	484-428-3813

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

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	01/19/2023

Similar Medicare Providers

1043212137 — PMA MEDICAL SPECIALISTS
Practice Location Address:

450 PARK WAY , SUITE 300
BROOMALL, PA
19008-4202

Practice Phone: 484-422-8080
Practice Fax: 484-422-8073

1972667004 — NATIONAL MENTOR HEALTHCARE LLC
Practice Location Address:

450 PARKWAY , SUITE 204
BROOMALL, PA
19008-4202

Practice Phone: 610-353-5332
Practice Fax: 610-353-2814

1457699977 — SYNERGY HOMECARE
Practice Location Address:

450 PARKWAY , SUITE C
BROOMALL, PA
19008-4202

Practice Phone: 610-265-2350
Practice Fax: 610-265-2581

1285040493 — STEPHANIE IANNUCCI LPC, LBS
Practice Location Address:

450 PARKWAY , #204
BROOMALL, PA
19008-4202

Practice Phone: 610-715-9613
Practice Fax:

1952766081 — DONNA LUONGO R.N.
Practice Location Address:

450 PARKWAY
BROOMALL, PA
19008-4202

Practice Phone: 610-931-9065
Practice Fax:

1902381429 — SEAMUS OCONNOR MA, MS, MT-BC
Practice Location Address:

450 PARK WAY
BROOMALL, PA
19008-4202

Practice Phone: 610-732-8683
Practice Fax:

Directions to “ JUSTIN JAMES DEPERMENTIER PT, DPT, ATC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.