Provider Demographics
NPI:1093409963
Name:ABALOS-BUCHANAN, JOSHUA WILLIAM (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:WILLIAM
Last Name:ABALOS-BUCHANAN
Suffix:
Gender:M
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 ASCENDING SUN LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-3615
Mailing Address - Country:US
Mailing Address - Phone:702-349-5294
Mailing Address - Fax:
Practice Address - Street 1:5850 POLARIS AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3185
Practice Address - Country:US
Practice Address - Phone:702-739-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5123261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy