Provider Demographics
NPI:1073071213
Name:LONGWORTH, JOSH (LMT)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:LONGWORTH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 E ELDORADO PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5508
Mailing Address - Country:US
Mailing Address - Phone:972-987-4672
Mailing Address - Fax:972-987-4693
Practice Address - Street 1:1395 E ELDORADO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5508
Practice Address - Country:US
Practice Address - Phone:972-987-4672
Practice Address - Fax:972-987-4693
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103513225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist