MEDICARE: HEATH JUSTIN DITTFURTH PT

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	225100000X	Physical Therapist	1191480	TX

General Provider Information

NPI Number	:	1326370503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATH JUSTIN DITTFURTH PT

Provider Business Mailing Address
First Line	:	1100 N BLUE MOUND RD
Second Line	:	SUITE 130
City	:	SAGINAW
State	:	TX
Zip	:	76131-4901
Country	:	US
Telephone Number	:	817-232-3553
Fax Number	:	817-232-7882

Provider Business Practice Location Address
First Line	:	1100 N BLUE MOUND RD
Second Line	:	SUITE 130
City	:	SAGINAW
State	:	TX
Zip	:	76131-4901
Country	:	US
Telephone Number	:	817-232-3553
Fax Number	:	817-232-7882

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

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	02/12/2010

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Directions to “ HEATH JUSTIN DITTFURTH PT” Practice Location

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