Provider Demographics
NPI:1760038590
Name:JOSEPH, BRIAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 LOST BALL DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-3854
Mailing Address - Country:US
Mailing Address - Phone:863-214-6880
Mailing Address - Fax:
Practice Address - Street 1:600 S PINE ISLAND RD STE 103
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3178
Practice Address - Country:US
Practice Address - Phone:954-474-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist