Healthcare Provider Details

I. General information

NPI: 1487455002
Provider Name (Legal Business Name): JUSTIN CHARLES GUPTIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EUREKA RD
ROSEVILLE CA
95661-3027
US

IV. Provider business mailing address

9481 HEINLEIN CT
SACRAMENTO CA
95829-6094
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-4000
  • Fax:
Mailing address:
  • Phone: 916-402-5449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number307766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: