Provider Demographics
NPI:1518152081
Name:JOSEPH, SANJEEV (MSPT)
Entity Type:Individual
Prefix:MR
First Name:SANJEEV
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 RANCH LAKE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3708
Mailing Address - Country:US
Mailing Address - Phone:941-417-8300
Mailing Address - Fax:941-417-8301
Practice Address - Street 1:5860 RANCH LAKE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3708
Practice Address - Country:US
Practice Address - Phone:941-417-8300
Practice Address - Fax:941-417-8301
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist