Healthcare Provider Details

I. General information

NPI: 1245509876
Provider Name (Legal Business Name): JOSHUA MISTIC DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date: 09/22/2019
Reactivation Date: 09/29/2022

III. Provider practice location address

1217 ANNE ST NW
BEMIDJI MN
56601-5113
US

IV. Provider business mailing address

1217 ANNE ST NW
BEMIDJI MN
56601-5113
US

V. Phone/Fax

Practice location:
  • Phone: 218-755-6360
  • Fax: 218-755-6399
Mailing address:
  • Phone: 218-755-6360
  • Fax: 218-755-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9181
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: