Healthcare Provider Details

I. General information

NPI: 1134857170
Provider Name (Legal Business Name): JOSHUA M WEINTRAUB DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 GUM BRANCH RD STE 600
JACKSONVILLE NC
28540-4008
US

IV. Provider business mailing address

2453 GUM BRANCH RD STE 600
JACKSONVILLE NC
28540-4008
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-9800
  • Fax: 910-455-2083
Mailing address:
  • Phone: 910-353-9800
  • Fax: 910-455-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: