Provider Demographics
NPI:1568996064
Name:BRAVO, JOSHUA DAVIS (DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVIS
Last Name:BRAVO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-777-6236
Mailing Address - Fax:423-777-6236
Practice Address - Street 1:5226 AIRLINE RD STE 131
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002
Practice Address - Country:US
Practice Address - Phone:901-441-7997
Practice Address - Fax:901-881-1577
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCP019222T225100000X
TN11430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist