Provider Demographics
NPI:1811075120
Name:SLATER, JOSHUA C (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:C
Last Name:SLATER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 GOLDEN CENTER DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-344-2045
Mailing Address - Fax:530-642-0794
Practice Address - Street 1:4300 GOLDEN CENTER DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-344-2045
Practice Address - Fax:530-642-0794
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABN116ZMedicare PIN