Healthcare Provider Details

I. General information

NPI: 1457227555
Provider Name (Legal Business Name): JOSHUA MEDINA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6884 HICKORY FLAT HWY
WOODSTOCK GA
30188-3229
US

IV. Provider business mailing address

2986 KALEY DR NW
KENNESAW GA
30152-2677
US

V. Phone/Fax

Practice location:
  • Phone: 770-704-8244
  • Fax: 770-704-8264
Mailing address:
  • Phone: 678-608-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018073
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: