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General NPI Number Information
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NPI Number | 1598331878
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Entity Type | Individual
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Provider Name | JUSTIN S NAM DPT
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Gender | Male
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 6325 MULTIPLEX DR
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City | CENTREVILLE
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State | VA
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Zip | 20121-5327
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Country | US
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Telephone | 571-932-3470
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Fax |
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Provider Business Mailing Address
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Address Line | 350 NEW FIDELITY CT
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City | GARNER
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State | NC
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Zip | 27529-2665
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Country | US
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Telephone | 919-258-2714
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Fax | 410-648-4878
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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 | 2305214339
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License Number State | VA
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