Provider Demographics
NPI:1841006491
Name:MINK, JOSHUA
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:MINK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 BRITTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3565
Mailing Address - Country:US
Mailing Address - Phone:330-647-4842
Mailing Address - Fax:
Practice Address - Street 1:4211 SR-44 #1400
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272
Practice Address - Country:US
Practice Address - Phone:330-754-2545
Practice Address - Fax:330-850-5243
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0143962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic