Provider Demographics
NPI:1467904060
Name:SELLS, JOSHUA JACOB
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JACOB
Last Name:SELLS
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 1:4332 TARA AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7445
Mailing Address - Country:US
Mailing Address - Phone:253-232-2159
Mailing Address - Fax:
Practice Address - Street 1:4332 TARA AVE
Practice Address - Street 2:APT. B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7445
Practice Address - Country:US
Practice Address - Phone:253-232-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner