Provider Demographics
NPI:1003901547
Name:LONG, JOSHUA CHRISTIAN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:CHRISTIAN
Last Name:LONG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 APPLING DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4688
Mailing Address - Country:US
Mailing Address - Phone:843-614-7429
Mailing Address - Fax:
Practice Address - Street 1:1469 APPLING DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4688
Practice Address - Country:US
Practice Address - Phone:843-614-7429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist