Healthcare Provider Details

I. General information

NPI: 1720919939
Provider Name (Legal Business Name): JOSHUA LEE FREEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 SHADOW LAKE BLVD
BATON ROUGE LA
70816-3797
US

IV. Provider business mailing address

3013 SHADOW LAKE BLVD
BATON ROUGE LA
70816-3797
US

V. Phone/Fax

Practice location:
  • Phone: 225-938-8971
  • Fax:
Mailing address:
  • Phone: 225-938-8971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: