MEDICARE: JUSTIN TOULON PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant
2	225100000X	Physical Therapist	PT60571927	WA

General Provider Information

NPI Number	:	1225684939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN TOULON PT, DPT

Provider Business Mailing Address
First Line	:	11022 OLALLA VALLEY RD SE
Second Line	:
City	:	OLALLA
State	:	WA
Zip	:	98359-9734
Country	:	US
Telephone Number	:	253-358-9232
Fax Number	:

Provider Business Practice Location Address
First Line	:	11022 OLALLA VALLEY RD SE
Second Line	:
City	:	OLALLA
State	:	WA
Zip	:	98359-9734
Country	:	US
Telephone Number	:	253-358-9232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2019
Last Update Date	:	08/18/2019

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Directions to “ JUSTIN TOULON PT, DPT” Practice Location

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