=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225841000
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUSTIN ALLAN DALMACIO DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8125 BIRCH BAY SQUARE ST STE 248
-----------------------------------------------------
City | BLAINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98230-9847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-366-5511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9989 BARNSTON DR E #75
-----------------------------------------------------
City | SURREY
-----------------------------------------------------
State | BRITISH COLUMBIA
-----------------------------------------------------
Zip | V4N6N3
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT61620758
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------