Provider Demographics
NPI:1629584263
Name:LALONDE, JUSTIN BRADY (PT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BRADY
Last Name:LALONDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2456
Mailing Address - Country:US
Mailing Address - Phone:480-202-3669
Mailing Address - Fax:
Practice Address - Street 1:508 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2456
Practice Address - Country:US
Practice Address - Phone:480-202-3669
Practice Address - Fax:619-415-8154
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2941912251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic