Provider Demographics
NPI:1538845193
Name:WAMPLER, JUSTIN DANIEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DANIEL
Last Name:WAMPLER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 TELEGRAPH RD STE E
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63129-4762
Mailing Address - Country:US
Mailing Address - Phone:314-988-2160
Mailing Address - Fax:314-988-2161
Practice Address - Street 1:6060 TELEGRAPH RD STE E
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:MO
Practice Address - Zip Code:63129-4762
Practice Address - Country:US
Practice Address - Phone:314-988-2160
Practice Address - Fax:314-988-2161
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023023358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist