Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Justin Provo

Individual provider Physical Therapist · NPI 1588553259

Justin Provo is a Physical Therapist in Private Practice in Melbourne, Florida. Qualified in 2025, 1 year ago. Practices with Peoples Physical Therapy Inc, an 18-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
1
Licensed in
FL
In the registry since
2025
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Practice location Address checks out

2200 W Eau Gallie Blvd Ste 105
Melbourne, FL 32935-3166
Phone: (255) 255-2818
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT43362 (FL)

Record details

NPI number1588553259
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 30, 2025
Last updated in NPPESAugust 7, 2025
Certification dateAugust 7, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Peoples Physical Therapy Inc — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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