Provider Demographics
NPI:1881029601
Name:ANDERSON, JOSHUA CHASE (PTA/L)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CHASE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 E MEADOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-7201
Mailing Address - Country:US
Mailing Address - Phone:425-232-9065
Mailing Address - Fax:
Practice Address - Street 1:15623 1ST AVE S STE C
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1292
Practice Address - Country:US
Practice Address - Phone:206-444-6320
Practice Address - Fax:206-444-3602
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60064421225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant