Provider Demographics
NPI:1538837307
Name:DIRKS, JUSTIN C (DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:C
Last Name:DIRKS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3161 E SPAULDING AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2816 JANITELL RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4141
Practice Address - Country:US
Practice Address - Phone:719-527-0848
Practice Address - Fax:719-471-4415
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPTL.0017923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist