Provider Demographics
NPI:1982216610
Name:BLOODWORTH, JOSHUA NOLAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:NOLAN
Last Name:BLOODWORTH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 DUNLEAF ARC WAY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3235
Mailing Address - Country:US
Mailing Address - Phone:478-919-6352
Mailing Address - Fax:
Practice Address - Street 1:2319 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6030
Practice Address - Country:US
Practice Address - Phone:706-425-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist