Healthcare Provider Details

I. General information

NPI: 1922678713
Provider Name (Legal Business Name): JUSTIN HOVEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 ASHLEY GARDEN BLVD UNIT 4307
CHARLESTON SC
29414-9224
US

IV. Provider business mailing address

1235 ASHLEY GARDEN BLVD UNIT 4307
CHARLESTON SC
29414-9224
US

V. Phone/Fax

Practice location:
  • Phone: 717-491-3165
  • Fax:
Mailing address:
  • Phone: 717-491-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: