Provider Demographics
NPI:1679769269
Name:JOSEPH, AJESH (BPT)
Entity Type:Individual
Prefix:
First Name:AJESH
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:BPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-2223
Mailing Address - Country:US
Mailing Address - Phone:903-640-4585
Mailing Address - Fax:214-354-1319
Practice Address - Street 1:2215 PECAN ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2223
Practice Address - Country:US
Practice Address - Phone:903-640-4585
Practice Address - Fax:214-354-1319
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist