MEDICARE: JUSTIN L PUGMIRE 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	225100000X	Physical Therapist	LPT-034153	AZ

General Provider Information

NPI Number	:	1881485316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN L PUGMIRE PT, DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 N STAPLEY DR STE 105
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-7281
Country	:	US
Telephone Number	:	480-729-8317
Fax Number	:

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

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	05/23/2025

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