Provider Demographics
NPI:1023398518
Name:GROOMS, JOSHUA WAYNE (LMP)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:WAYNE
Last Name:GROOMS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 20TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-1526
Mailing Address - Country:US
Mailing Address - Phone:360-281-6052
Mailing Address - Fax:
Practice Address - Street 1:528 20TH ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-1526
Practice Address - Country:US
Practice Address - Phone:360-281-6052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60233879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist