Provider Demographics
NPI:1740954924
Name:MCLAIN, JOSHUA (PT)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:MCLAIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 TERMINAL RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2516
Mailing Address - Country:US
Mailing Address - Phone:612-400-7872
Mailing Address - Fax:
Practice Address - Street 1:2280 TERMINAL RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2516
Practice Address - Country:US
Practice Address - Phone:612-400-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10361261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10361OtherPT LICENSE