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NPI Code Detail

MEDICARE: DR. JUSTIN CRAIG SUDLOW DPT

MEDICARE: DR. JUSTIN CRAIG SUDLOW 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
1225100000XPhysical Therapist40QA01377700NJ
22251X0800XOrthopedic Physical Therapist40QA01377700NJ
3225100000XPhysical TherapistP100106ENC

General Provider Information

NPI Number : 1841500022
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN CRAIG SUDLOW DPT
Provider Business Mailing Address
First Line : 1377 MOTOR PKWY STE 307
Second Line :
City : ISLANDIA
State : NY
Zip : 11749-5258
Country : US
Telephone Number :
Fax Number : 631-760-8306
Provider Business Practice Location Address
First Line : 9216 ARDREY KELL RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-4954
Country : US
Telephone Number : 980-556-7330
Fax Number : 980-939-8215
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2010
Last Update Date : 08/14/2020

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