Healthcare Provider Details

I. General information

NPI: 1093423691
Provider Name (Legal Business Name): JOSHUA FRANCIS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 ALDER ST
BROOKINGS OR
97415-9014
US

IV. Provider business mailing address

PO BOX 6969
BROOKINGS OR
97415-0355
US

V. Phone/Fax

Practice location:
  • Phone: 541-813-1863
  • Fax:
Mailing address:
  • Phone: 541-373-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18334
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: