Active NPI
David Justice
- Occupational Therapy Assistant
- Timberlake, NC
National Provider Identifier
1043756422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 9900
- Practice address
- 450 CC Andrews Rd
Timberlake, NC 27583-8935 - Phone
- (505) 803-1643
- NPI assigned
- Jan 10, 2017
- Last updated
- Jan 10, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 9900 | NC | Primary |
Addresses
Primary practice location
450 CC Andrews Rd
Timberlake, NC 27583-8935
Mailing address
450 CC Andrews Rd
Timberlake, NC 27583-8935
Phone (505) 803-1643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9900 | NC | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484006400000",
"number": "1043756422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 CC ANDREWS RD",
"city": "TIMBERLAKE",
"state": "NC",
"postal_code": "275838935",
"telephone_number": "505-803-1643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 CC ANDREWS RD",
"city": "TIMBERLAKE",
"state": "NC",
"postal_code": "275838935",
"telephone_number": "505-803-1643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUSTICE",
"first_name": "DAVID",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-10",
"last_updated": "2017-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NC",
"license": "9900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Timberlake, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.