Provider Demographics
NPI:1942075981
Name:BAGLEY, JOSHUA STUART (DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:STUART
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9549 FRANKFORT AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6107
Mailing Address - Country:US
Mailing Address - Phone:903-505-9765
Mailing Address - Fax:
Practice Address - Street 1:3178 HAMNER AVE STE 4
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1936
Practice Address - Country:US
Practice Address - Phone:951-736-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist