Healthcare Provider Details

I. General information

NPI: 1336753946
Provider Name (Legal Business Name): JOSHUA TALLARITO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 GRAND AVE
COWEN WV
26206-8591
US

IV. Provider business mailing address

501 WILSON LN
ELKINS WV
26241-5216
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-9326
  • Fax:
Mailing address:
  • Phone: 304-636-9326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: