Provider Demographics
NPI:1659839058
Name:MAYHAN, JOSEPH WAYNE (ATS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WAYNE
Last Name:MAYHAN
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 PAMPLONA WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2016
Mailing Address - Country:US
Mailing Address - Phone:209-604-4516
Mailing Address - Fax:
Practice Address - Street 1:2829 PAMPLONA WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2016
Practice Address - Country:US
Practice Address - Phone:209-604-4516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty