Provider Demographics
NPI:1417641135
Name:MCCALLUM, JOSHUA JOHN (PT DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOHN
Last Name:MCCALLUM
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 BATH AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-3685
Mailing Address - Country:US
Mailing Address - Phone:606-324-0540
Mailing Address - Fax:606-324-0616
Practice Address - Street 1:11 VAUGHNS GAP RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-4303
Practice Address - Country:US
Practice Address - Phone:615-988-6852
Practice Address - Fax:606-324-0616
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty