Provider Demographics
NPI:1033995881
Name:MCNUTT, JOSHUA OWEN (DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:OWEN
Last Name:MCNUTT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 MUKILTEO SPEEDWAY STE 503
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:760 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WATER MILL
Practice Address - State:NY
Practice Address - Zip Code:11976-2600
Practice Address - Country:US
Practice Address - Phone:631-812-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6344225100000X
WA61476396225100000X
NY050766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist