Healthcare Provider Details

I. General information

NPI: 1902881675
Provider Name (Legal Business Name): JUSTIN ZEBULON LAFERRIER MSPT, OCS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4501
US

IV. Provider business mailing address

136 SEFORD DR
SAN ANTONIO TX
78209-6035
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-2154
  • Fax:
Mailing address:
  • Phone: 401-261-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberPT01734
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: