Healthcare Provider Details

I. General information

NPI: 1831776848
Provider Name (Legal Business Name): JUSTIN LUIS MACHADO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 SABLE PINE CIR APT 950D2
WEST PALM BEACH FL
33417-2798
US

IV. Provider business mailing address

4751 SABLE PINE CIR APT 950D2
WEST PALM BEACH FL
33417-2798
US

V. Phone/Fax

Practice location:
  • Phone: 786-348-1602
  • Fax:
Mailing address:
  • Phone: 786-348-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT36947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: