Healthcare Provider Details

I. General information

NPI: 1083230460
Provider Name (Legal Business Name): JUSTIN THOMAS DAVID DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 CASTLE SHANNON BLVD
PITTSBURGH PA
15234-1431
US

IV. Provider business mailing address

433 CASTLE SHANNON BLVD
PITTSBURGH PA
15234-1431
US

V. Phone/Fax

Practice location:
  • Phone: 412-344-9044
  • Fax: 412-344-9047
Mailing address:
  • Phone: 412-344-9044
  • Fax: 412-344-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT028539
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: