Individual provider Active NPI

Justin Stein

  • Physical Therapist
  • Phoenix, AZ
National Provider Identifier
1417325028
Registry record updated Oct 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11779 Issued in AZ
Practice address
402 E Greenway Pkwy
#12
Phoenix, AZ 85022-2350
Phone
(602) 789-6878
NPI assigned
Sep 14, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11779 AZ Primary

Addresses

Primary practice location

402 E Greenway Pkwy
#12
Phoenix, AZ 85022-2350

Mailing address

81 Makawao Ave
Ste 110
Makawao, HI 96768-8859
Phone (808) 572-2281

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
11779AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy at Pukalani, LLC Physical Therapist CurrentSince Mar 16, 2021 Accepting new patients
Boundless Breath LLC Physical Therapist CurrentSince Dec 29, 2019 Accepting new patients
Vibrantcare Outpatient Rehabilitation West Inc Past Accepting new patients
Vibrantcare Outpatient Rehabilitation West Inc Past Accepting new patients

Locations

81 Makawao Ave
Ste 110
Makawao, HI 96768
Phone (808) 572-2281

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538524800000",
    "number": "1417325028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 MAKAWAO AVE",
            "address_2": "STE 110",
            "city": "MAKAWAO",
            "state": "HI",
            "postal_code": "967688859",
            "telephone_number": "808-572-2281",
            "fax_number": "808-573-5869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 E GREENWAY PKWY",
            "address_2": "#12",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850222350",
            "telephone_number": "602-789-6878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEIN",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-14",
        "last_updated": "2018-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "11779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; 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.