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General NPI Number Information
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NPI Number | 1871239756
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Entity Type | Individual
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Provider Name | JUSTIN JAQUETTE DPT
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Gender | Male
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Dates
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Enumeration Date | 05/12/2022
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 5400 BRODIE LN STE 295
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City | SUNSET VALLEY
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State | TX
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Zip | 78745-2525
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Country | US
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Telephone | 512-676-3949
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 BUTTERFIELD RD STE 1600
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1211
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Country | US
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Telephone |
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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 | PT030629
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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