Provider Demographics
NPI:1831276369
Name:ADDIS, JOSHUA SCOTT (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SCOTT
Last Name:ADDIS
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:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-0024
Mailing Address - Country:US
Mailing Address - Phone:740-550-4128
Mailing Address - Fax:740-422-0516
Practice Address - Street 1:129 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-1140
Practice Address - Country:US
Practice Address - Phone:740-550-4128
Practice Address - Fax:740-422-0516
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPTA A02112225200000X
OHPTA 05947225200000X
OHPT019658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant