Provider Demographics
NPI:1104396126
Name:ROTHWELL, JOSHUA RYAN
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:RYAN
Last Name:ROTHWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 E STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-1773
Mailing Address - Country:US
Mailing Address - Phone:317-604-5183
Mailing Address - Fax:317-291-3376
Practice Address - Street 1:1209 E STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1773
Practice Address - Country:US
Practice Address - Phone:317-604-5183
Practice Address - Fax:317-291-3376
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001513A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist