MEDICARE: JUSTIN JOHN FESLER 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	PT29628	CA

General Provider Information

NPI Number	:	1902987100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN JOHN FESLER DPT

Provider Business Mailing Address
First Line	:	24431 CALLE DE LA LOUISA
Second Line	:	200
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-7641
Country	:	US
Telephone Number	:	949-837-9074
Fax Number	:	949-837-9078

Provider Business Practice Location Address
First Line	:	26034 ACERO
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-2768
Country	:	US
Telephone Number	:	949-837-9074
Fax Number	:	949-837-9078

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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