Provider Demographics
NPI:1023006608
Name:FALLIN, JOSHUA HOWARD (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:HOWARD
Last Name:FALLIN
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 SUMMERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8236
Mailing Address - Country:US
Mailing Address - Phone:336-946-0322
Mailing Address - Fax:336-946-0322
Practice Address - Street 1:401 DEACON BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-4216
Practice Address - Country:US
Practice Address - Phone:336-759-7200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer