Provider Demographics
NPI:1487714895
Name:TRAINOR, JUSTIN DIXON (MSPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DIXON
Last Name:TRAINOR
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1005 N FREDERICK AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-1018
Practice Address - Country:US
Practice Address - Phone:563-578-2139
Practice Address - Fax:563-578-2156
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist