Provider Demographics
NPI:1033439211
Name:HUCKINS, JOEL BERNARD (PT)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:BERNARD
Last Name:HUCKINS
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 1:201 W MADISON AVE
Mailing Address - Street 2:PHYSICAL THERAPY DEPT.
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2806
Mailing Address - Country:US
Mailing Address - Phone:518-762-4548
Mailing Address - Fax:518-736-1570
Practice Address - Street 1:201 W MADISON AVE
Practice Address - Street 2:PHYSICAL THERAPY DEPT.
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2806
Practice Address - Country:US
Practice Address - Phone:518-762-4548
Practice Address - Fax:518-736-1570
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023033-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist