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General NPI Number Information
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NPI Number | 1487455002
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Entity Type | Individual
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Provider Name | JUSTIN CHARLES GUPTIL
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Gender | Male
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1600 EUREKA RD
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City | ROSEVILLE
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State | CA
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Zip | 95661-3027
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Country | US
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Telephone | 916-784-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 9481 HEINLEIN CT
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City | SACRAMENTO
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State | CA
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Zip | 95829-6094
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Country | US
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Telephone | 916-402-5449
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 307766
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License Number State | CA
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