Healthcare Provider Details

I. General information

NPI: 1316240278
Provider Name (Legal Business Name): JOSHUA ROBERT JEFFREY ATC, EMT-B
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 E 13TH ST
LOVELAND CO
80537-4935
US

IV. Provider business mailing address

509 E 13TH ST
LOVELAND CO
80537-4935
US

V. Phone/Fax

Practice location:
  • Phone: 260-602-2745
  • Fax:
Mailing address:
  • Phone: 260-602-2745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number052249
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number917
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: