Provider Demographics
NPI:1043934193
Name:HARBOLT, JOEL (DPT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:HARBOLT
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 1:315 NE CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-4006
Mailing Address - Country:US
Mailing Address - Phone:503-913-0877
Mailing Address - Fax:
Practice Address - Street 1:1561 POTOMAC GREENS DR STE 1A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-6255
Practice Address - Country:US
Practice Address - Phone:703-717-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR644902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic