Provider Demographics
NPI: | 1003560400 |
---|---|
Name: | STEPHENS, JOSHUA (DPT) |
Entity Type: | Individual |
Prefix: | |
First Name: | JOSHUA |
Middle Name: | |
Last Name: | STEPHENS |
Suffix: | |
Gender: | M |
Credentials: | DPT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 235 VAN MAR DR |
Mailing Address - Street 2: | |
Mailing Address - City: | WYTHEVILLE |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 24382-4136 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 276-620-9546 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 235 VAN MAR DR |
Practice Address - Street 2: | |
Practice Address - City: | WYTHEVILLE |
Practice Address - State: | VA |
Practice Address - Zip Code: | 24382-4136 |
Practice Address - Country: | US |
Practice Address - Phone: | 276-620-9546 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2022-02-05 |
Last Update Date: | 2022-02-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics |
No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | |
No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WV | 004021 | Other | PHYSICAL THERAPY LICENSE |