Provider Demographics
NPI:1205100708
Name:SOWDERS, JOSHUA KEITH (PTA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KEITH
Last Name:SOWDERS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7675 OAK HILL RD NE
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:43107-9711
Mailing Address - Country:US
Mailing Address - Phone:740-304-2772
Mailing Address - Fax:
Practice Address - Street 1:2000 REGENCY MANOR CIR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1777
Practice Address - Country:US
Practice Address - Phone:614-445-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7644225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant