Healthcare Provider Details

I. General information

NPI: 1639960040
Provider Name (Legal Business Name): JOSHUA RUSSELL RRT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 LAMONT ST
JOHNSON CITY TN
37604-5453
US

IV. Provider business mailing address

216 GRANDVIEW ST
MOUNT CARMEL TN
37645-3687
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: