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

Justin Ullom

Individual provider Athletic Trainer · NPI 1538626007

Justin Ullom is an Athletic Trainer in Saint Louis, Missouri. Licensed in Missouri. Registered with an NPI since 2019.

Licensed in
MO
In the registry since
2019
Specialties on file
3

Practice location Address checks out

1111 Victor St
Saint Louis, MO 63104-4323
Phone: (636) 236-5756
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence 2020008148 (MO)
Athletic Trainer Taxonomy 2255A2300X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1538626007
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 21, 2019
Last updated in NPPESApril 20, 2020
Certification dateApril 20, 2020
Mailing address1911 S 11th St Apt C, Saint Louis, MO 63104-4089

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