Provider Demographics
NPI:1043671746
Name:YOUNGLESON, JUSTINE ANDREA (LMT, AIS)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ANDREA
Last Name:YOUNGLESON
Suffix:
Gender:F
Credentials:LMT, AIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SW 12TH AVE
Mailing Address - Street 2:# 102
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3119
Mailing Address - Country:US
Mailing Address - Phone:954-754-5277
Mailing Address - Fax:
Practice Address - Street 1:160 SW 12TH AVE
Practice Address - Street 2:# 102
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3119
Practice Address - Country:US
Practice Address - Phone:954-754-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA81322172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist