MEDICARE: JOSHUA ECHELSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA 26599	FL
2	225700000X	Massage Therapist	MA95194	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTA 26599	OTHER	FL	PTA LICENSE

General Provider Information

NPI Number	:	1942654157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA ECHELSON

Provider Business Mailing Address
First Line	:	1338 DEL PRADO BLVD S STE F
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3714
Country	:	US
Telephone Number	:	239-823-3370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 DEL PRADO BLVD S STE F
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3714
Country	:	US
Telephone Number	:	239-823-3370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	12/20/2023

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Directions to “ JOSHUA ECHELSON ” Practice Location

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