Provider Demographics
NPI:1902163074
Name:ROTHSCHILD, JUSTIN (ATC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:ROTHSCHILD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 630264
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33163-0264
Mailing Address - Country:US
Mailing Address - Phone:786-512-6448
Mailing Address - Fax:305-919-2001
Practice Address - Street 1:2601 NE 151ST ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4653
Practice Address - Country:US
Practice Address - Phone:786-512-6448
Practice Address - Fax:305-919-2001
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 14112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer