Provider Demographics
NPI:1972254894
Name:VICTOR, JOSHUA
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:VICTOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 NORTH JUNIATA STREET
Mailing Address - Street 2:STE A
Mailing Address - City:LEWISTON
Mailing Address - State:PA
Mailing Address - Zip Code:17044
Mailing Address - Country:US
Mailing Address - Phone:717-953-9643
Mailing Address - Fax:717-953-9661
Practice Address - Street 1:71 NORTH JUNIATA STREET
Practice Address - Street 2:STE A
Practice Address - City:LEWISTON
Practice Address - State:PA
Practice Address - Zip Code:17044
Practice Address - Country:US
Practice Address - Phone:717-953-9643
Practice Address - Fax:717-953-9661
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist