Provider Demographics
NPI:1801375183
Name:ELMER, JOSHUA GERARD (ATC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:GERARD
Last Name:ELMER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13004 AULDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-2289
Mailing Address - Country:US
Mailing Address - Phone:651-341-0729
Mailing Address - Fax:
Practice Address - Street 1:500 E WATERMAN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4509
Practice Address - Country:US
Practice Address - Phone:316-440-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer