Provider Demographics
NPI:1346617305
Name:REED, JOSHUA DALE (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:DALE
Last Name:REED
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 1:6171 N SHERIDAN RD
Mailing Address - Street 2:APT 2804
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2810
Mailing Address - Country:US
Mailing Address - Phone:517-242-4190
Mailing Address - Fax:
Practice Address - Street 1:6171 N SHERIDAN RD
Practice Address - Street 2:APT 2804
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-2810
Practice Address - Country:US
Practice Address - Phone:517-242-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007067225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant