Healthcare Provider Details

I. General information

NPI: 1124877519
Provider Name (Legal Business Name): JOSHUA FREYHOLTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1350
US

IV. Provider business mailing address

1204 DECATOR DR
WAUSAU WI
54401-1964
US

V. Phone/Fax

Practice location:
  • Phone: 612-330-1757
  • Fax:
Mailing address:
  • Phone: 715-642-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: