Provider Demographics
NPI:1346009164
Name:ATKINSON, JOSHUA R (PTA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 E GREENWAY ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-4419
Mailing Address - Country:US
Mailing Address - Phone:480-388-7842
Mailing Address - Fax:
Practice Address - Street 1:3514 N POWER RD STE 133
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2911
Practice Address - Country:US
Practice Address - Phone:480-625-6693
Practice Address - Fax:480-304-3269
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCP029887A225200000X
AZPTA-014529225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant