Healthcare Provider Details

I. General information

NPI: 1891000584
Provider Name (Legal Business Name): JUSTIN T JIUNTA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 GREEN ST
PHILADELPHIA PA
19123-2945
US

IV. Provider business mailing address

1129 E PALMER ST
PHILADELPHIA PA
19125-4220
US

V. Phone/Fax

Practice location:
  • Phone: 215-550-1257
  • Fax:
Mailing address:
  • Phone: 570-709-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0015075
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-020831
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: