Justin Wayne Long, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT008689 Issued in GA

Practice address

2085 Hamilton Creek Pkwy
Suite 160
Dacula, GA 30019

Phone

(770) 271-1488

Fax

(770) 271-1822

NPI assigned

Sep 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Elite Sports Medicine

  • Physical Therapist
  • Dacula, GA
  • NPI 1861408239
  NPD (past)

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184728263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 SABLE CROSSING",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "30024",
            "telephone_number": "417-234-9856",
            "fax_number": "770-271-1822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2085 HAMILTON CREEK PKWY",
            "address_2": "SUITE 160",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "30019",
            "telephone_number": "770-271-1488",
            "fax_number": "770-271-1822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "JUSTIN",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT008689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gretchen Lionberger
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• Living Water ABA LLC
• Kang-Sha Lo
• Haley Lorimer, MS, CCC-SLP
• Enoch Marrell Lowe, M.D.
• Tricia A Lowrie, LMT
• Allen D. Lukens, LCSW
• Luxury Perspectives, LLC

• Physical Therapist in Dacula, GA
• Providers in Dacula, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.