Healthcare Provider Details

I. General information

NPI: 1003459116
Provider Name (Legal Business Name): JOSHUA PIKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. JOSHUA DARRYL PIKE

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 HAVERSHIRE BLVD
STATE COLLEGE PA
16803-4610
US

IV. Provider business mailing address

2905 SPRUCE AVE
ALTOONA PA
16601-1631
US

V. Phone/Fax

Practice location:
  • Phone: 814-325-9755
  • Fax:
Mailing address:
  • Phone: 814-329-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI005498
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: