Provider Demographics
NPI:1487009650
Name:MCCUNE, JOSH DAVID (LMP)
Entity Type:Individual
Prefix:MR
First Name:JOSH
Middle Name:DAVID
Last Name:MCCUNE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 E MARIETTA AVE APT 25
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-5537
Mailing Address - Country:US
Mailing Address - Phone:509-220-9143
Mailing Address - Fax:
Practice Address - Street 1:3121 E MARIETTA AVE APT 25
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-5537
Practice Address - Country:US
Practice Address - Phone:509-220-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60623289225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist