Provider Demographics
NPI:1124901939
Name:LAFFERTY, JUSTIN (ATC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:LAFFERTY
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 1:611 11TH ST NE APT 2
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-3429
Mailing Address - Country:US
Mailing Address - Phone:305-434-2876
Mailing Address - Fax:
Practice Address - Street 1:6000 COLLEGE LN
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58405-0001
Practice Address - Country:US
Practice Address - Phone:701-252-3467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer