Provider Demographics
NPI:1033304381
Name:TENNANT, JOSHUA (PT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:TENNANT
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 1:7503 SURRATTS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3358
Mailing Address - Country:US
Mailing Address - Phone:301-870-7001
Mailing Address - Fax:301-870-6697
Practice Address - Street 1:103 CENTENNIAL ST
Practice Address - Street 2:SUITE H
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5984
Practice Address - Country:US
Practice Address - Phone:301-997-0172
Practice Address - Fax:301-997-0175
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDT6108208100000X
OH11996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation