Provider Demographics
NPI:1932379328
Name:FEENEY, JOSHUA C (DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:C
Last Name:FEENEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:C
Other - Last Name:FEENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:3580 ARCADE ST
Mailing Address - Street 2:STE 150
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3580 ARCADE ST STE 150
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-7135
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8677225100000X
CA36730225100000X
IL070-016238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056608OtherMEDICARE
IAI18344009OtherIOWA MEDICARE NO
IA004224OtherIOWA PT LICENSE
ILK50540OtherILLINOIS MEDICARE PTAN
IL070-016238OtherILLINOIS PT LICENSE NO