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General NPI Number Information
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NPI Number | 1407073026
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Entity Type | Individual
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Provider Name | AMY L JUSTICE PTA
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 195 FALCON DRIVE
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City | FREDERICKSBURG
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State | VA
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Zip | 22408
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Country | US
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Telephone | 540-735-0260
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Fax | 540-735-5262
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Provider Business Mailing Address
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Address Line | 11017 TANEY DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22407
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Country | US
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Telephone | 540-735-0260
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Fax | 540-735-0262
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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 | 2306000889
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License Number State | VA
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