Doctor Name: | MR. JUSTIN WAYNE LONG |
NPI Number: | 1184728263 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MPT |
License Number: | PT008689 |
Business Practice Address: | 2085 Hamilton Creek Pkwy Suite 160 Dacula, GA - 30019 |
Business Phone Number: | 7702711488 |
Business Fax Number: | 7702711822 |
Mailing Address: | 1013 Sable Crossing, SUWANEE |
State: | GA |
Postal Code: | 30024 |
Phone Number: | 4172349856 |
Fax Number: | 7702711822 |
NPI Enumeration Date: | 09/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT008689 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |