Healthcare Provider Details

I. General information

NPI: 1417480914
Provider Name (Legal Business Name): JOSHUA KOTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

21 BAY COLONY DR
FORT LAUDERDALE FL
33308-2001
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-2302
  • Fax:
Mailing address:
  • Phone: 954-298-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101265151
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: