Provider Demographics
NPI:1730622218
Name:ROPER, JUSTINE WILLIAMS (DPT)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:WILLIAMS
Last Name:ROPER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 AIRPORT BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8623
Mailing Address - Country:US
Mailing Address - Phone:850-450-2081
Mailing Address - Fax:
Practice Address - Street 1:1108 AIRPORT BLVD STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8623
Practice Address - Country:US
Practice Address - Phone:850-450-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT872023225100000X
FLPT33484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty