Healthcare Provider Details

I. General information

NPI: 1710538749
Provider Name (Legal Business Name): JOSHUA STURGES PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N EUCLID ST STE 680
ANAHEIM CA
92801-5509
US

IV. Provider business mailing address

1730 E HOLLY AVE
EL SEGUNDO CA
90245-4404
US

V. Phone/Fax

Practice location:
  • Phone: 714-780-0010
  • Fax:
Mailing address:
  • Phone: 844-467-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: