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General NPI Number Information
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NPI Number | 1285909507
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Entity Type | Individual
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Provider Name | JUSTIN NEIDICH LPT
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Gender | Male
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 3434 NE 12TH AVE
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City | OAKLAND PARK
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State | FL
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Zip | 33334-4523
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Country | US
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Telephone | 954-900-8842
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Fax |
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Provider Business Mailing Address
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Address Line | 7465 NW 1ST MNR
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City | PLANTATION
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State | FL
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Zip | 33317-2270
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Country | US
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Telephone | 954-213-8194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01437200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT35221
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License Number State | FL
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