Healthcare Provider Details

I. General information

NPI: 1639995947
Provider Name (Legal Business Name): JUSTIN ESPARTERO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PONCE DE LEON ST
ROYAL PALM BEACH FL
33411-1213
US

IV. Provider business mailing address

12827 ANTHORNE LN
BOYNTON BEACH FL
33436-2204
US

V. Phone/Fax

Practice location:
  • Phone: 561-791-9090
  • Fax:
Mailing address:
  • Phone: 410-660-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: