Provider Demographics
NPI:1083755680
Name:WASHINGTON, JOSCELYN C (MPT)
Entity Type:Individual
Prefix:
First Name:JOSCELYN
Middle Name:C
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4959 PALO VERDE ST 109C
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2358
Mailing Address - Country:US
Mailing Address - Phone:909-971-3092
Mailing Address - Fax:310-861-1617
Practice Address - Street 1:4959 PALO VERDE ST 109C
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2358
Practice Address - Country:US
Practice Address - Phone:909-971-3092
Practice Address - Fax:310-861-1617
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28944225100000X, 2251N0400X, 2251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ59598Medicare UPIN
CAWPT28944AMedicare ID - Type Unspecified