Healthcare Provider Details

I. General information

NPI: 1336791128
Provider Name (Legal Business Name): JOSHUA JAY CARON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 PENEWIT RD
SPRING VALLEY OH
45370-8776
US

IV. Provider business mailing address

2727 PENEWIT RD
SPRING VALLEY OH
45370-8776
US

V. Phone/Fax

Practice location:
  • Phone: 520-591-0817
  • Fax:
Mailing address:
  • Phone: 520-591-0817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA012178
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: