Provider Demographics
NPI:1467288258
Name:PITTERLE, JOSHUA JOHN
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOHN
Last Name:PITTERLE
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 1:5183 N DESERT LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-9317
Mailing Address - Country:US
Mailing Address - Phone:480-323-8588
Mailing Address - Fax:
Practice Address - Street 1:7749 E FLORENTINE RD STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1205
Practice Address - Country:US
Practice Address - Phone:928-772-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-27743225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist