Provider Demographics
NPI:1336681048
Name:MOULES, JOSHUA KEIL
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KEIL
Last Name:MOULES
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 1:28 W HOLLENBACK AVE
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2610
Mailing Address - Country:US
Mailing Address - Phone:570-472-2519
Mailing Address - Fax:
Practice Address - Street 1:28 W HOLLENBACK AVE
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2610
Practice Address - Country:US
Practice Address - Phone:570-472-2519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer