Justin Nicholas Victor, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60747438 Issued in WA

Practice address

2900 Charlevoix Dr SE
#200
Grand Rapids, MI 49546-7085

Phone

(616) 975-5000

NPI assigned

Aug 27, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565136000000",
    "number": "1043610074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15285 OCEANA AVE",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "481011955",
            "telephone_number": "313-587-0812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 CHARLEVOIX DR SE",
            "address_2": "#200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467085",
            "telephone_number": "616-975-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICTOR",
        "first_name": "JUSTIN",
        "middle_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-27",
        "last_updated": "2019-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60747438",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501016888",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Vickery, CNA
• Vicki Nelson Smeby Ma LLP LLC
• Vicki Poleni LMSW
• Vicki Steenbergen LMSW
• Jennifer Lynn Victor, LLMSW
• Diana Victorino-Tellez
• Victory Palace
• Ann Elisabeth Victory, MD
• Vida Wellness
• Kaile Videtich, LLMFT

• Physical Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.