Healthcare Provider Details

I. General information

NPI: 1710146881
Provider Name (Legal Business Name): JOSHUA AUGUSTUS CADWALLADER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5232 KYLER AVE NE STE C
ALBERTVILLE MN
55301-4634
US

IV. Provider business mailing address

5232 KYLER AVE NE STE C
ALBERTVILLE MN
55301-4634
US

V. Phone/Fax

Practice location:
  • Phone: 763-260-5313
  • Fax: 833-599-7671
Mailing address:
  • Phone: 763-260-5313
  • Fax: 833-599-7671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10532
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: