Provider Demographics
NPI:1578045035
Name:KLEINER, JOSHUA DOUGLAS
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DOUGLAS
Last Name:KLEINER
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 1:31 LYNNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:43910-7842
Mailing Address - Country:US
Mailing Address - Phone:740-461-4291
Mailing Address - Fax:
Practice Address - Street 1:31 LYNNWOOD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:OH
Practice Address - Zip Code:43910-7842
Practice Address - Country:US
Practice Address - Phone:740-461-4291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer