Justin David Waldorf, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT4423 Issued in AR

Practice address

3344 N Futrall Dr
Fayetteville, AR 72703-4057

Phone

(479) 582-7213

Fax

(479) 582-7329

NPI assigned

Feb 27, 2012

Last updated

Aug 19, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA, AR2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Associates of Northwest Arkansas, PAGroup PAC ID 3678542073, 102 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: justin.waldorf@mana.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medical Associates of Northwest Arkansas, PA

  • Internal Medicine Physician
  • Fayetteville, AR
  • NPI 1801847827
  Medicare reassignment Care Compare group NPD
• Houston Orthopedic Surgery & Sports Medicine, P.C.

  • Orthopaedic Surgery Physician
  • Warner Robins, GA
  • NPI 1205866605
  Medicare reassignment NPD
• Medical Associates of Northwest Arkansas PA

  • Family Medicine Physician
  • Rogers, AR
  • NPI 1881029627
  NPD
• Medical Associates of Northwest Arkansas PA

  • Family Medicine Physician
  • Lowell, AR
  • NPI 1912883273
  NPD
• Houston Orthopedic Surgery & Sports Medicine, P.C.

  dba Middle Georgia Orthopedics

  • Durable Medical Equipment & Medical Supplies
  • Perry, GA
  • NPI 1134563042
  NPD
• Medical Associates of Northwest Arkansas PA

  • Podiatrist
  • Fayetteville, AR
  • NPI 1164140729
  NPD (past)
• Medical Associates of Northwest Arkansas PA

  • Family Medicine Physician
  • Fayetteville, AR
  • NPI 1710218995
  NPD (past)

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

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1114291838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1523",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727021523",
            "telephone_number": "479-571-6038",
            "fax_number": "479-582-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3344 N FUTRALL DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034057",
            "telephone_number": "479-582-7213",
            "fax_number": "479-582-7329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDORF",
        "first_name": "JUSTIN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-02-27",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT4423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "justin.waldorf@mana.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Provider's Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "6636 W Sunset Ave Ste C",
            "city": "Springdale",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727620971",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Allie Frances Wakefield, LPEI
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• Wal-Mart Stores, Inc. (Vision Center 30-0144)
• Emily Rodgers Waldorf, P.T.
• Walgreen Co (Walgreens #07718)
• Walgreen Co (Walgreens #05475)
• Walgreen Co (Walgreens #13118)
• Walgreen Co (Walgreens #07847)
• Walgreen Co (Walgreens #11988)

• Physical Therapist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.