Provider Demographics
NPI:1023551140
Name:SHALLCROSS, JOSHUA (PTA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:SHALLCROSS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2182 GALLATIN PIKE NORTH
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072
Mailing Address - Country:US
Mailing Address - Phone:615-859-7775
Mailing Address - Fax:
Practice Address - Street 1:2182 GALLATIN PIKE NORTH
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072
Practice Address - Country:US
Practice Address - Phone:615-859-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000005936225200000X
KYA03070225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant