Provider Demographics
NPI:1760887483
Name:MALONEY, JOSHUA LUCAS
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LUCAS
Last Name:MALONEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:LUCAS
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:147 LINKS DR
Mailing Address - Street 2:38J
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-5213
Mailing Address - Country:US
Mailing Address - Phone:931-472-9908
Mailing Address - Fax:
Practice Address - Street 1:102 W RAILROAD AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2154
Practice Address - Country:US
Practice Address - Phone:601-892-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist