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NPI Code Detail

MEDICARE: DR. JUSTIN WALTRIP

MEDICARE: DR. JUSTIN WALTRIP
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1689078339
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN WALTRIP
Provider Business Mailing Address
First Line : 1251 STILLWATER TRAIL
Second Line :
City : LAWTON
State : OK
Zip : 73507
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4301 WILSON ST
Second Line :
City : LAWTON
State : OK
Zip : 73503-4472
Country : US
Telephone Number : 580-558-8415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2014
Last Update Date : 10/09/2014

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Directions to “ DR. JUSTIN WALTRIP ” Practice Location

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