Provider Demographics
NPI:1003459116
Name:PIKE, JOSHUA
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:PIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOSHUA
Other - Middle Name:DARRYL
Other - Last Name:PIKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2905 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1631
Mailing Address - Country:US
Mailing Address - Phone:814-329-1212
Mailing Address - Fax:
Practice Address - Street 1:121 HAVERSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-4610
Practice Address - Country:US
Practice Address - Phone:814-325-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225200000X
PATEI005498225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty