Provider Demographics
NPI:1528184710
Name:SAMMONS, JOSHUA MICHIAL (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:MICHIAL
Last Name:SAMMONS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-2125
Mailing Address - Country:US
Mailing Address - Phone:507-831-0031
Mailing Address - Fax:
Practice Address - Street 1:2150 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1287
Practice Address - Country:US
Practice Address - Phone:507-831-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist