Provider Demographics
NPI:1750886388
Name:VANDER WINDT, JOSHUA WAYNE (PT)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:WAYNE
Last Name:VANDER WINDT
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 1:731 LEIGHTON AVE
Mailing Address - Street 2:#405
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207
Mailing Address - Country:US
Mailing Address - Phone:256-236-4121
Mailing Address - Fax:
Practice Address - Street 1:731 LEIGHTON AVE STE 405
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5766
Practice Address - Country:US
Practice Address - Phone:256-236-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist