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General NPI Number Information
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NPI Number | 1043468515
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Entity Type | Individual
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Provider Name | MICHAEL G. JOSEPH PT, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 3121 UNIVERSITY DR E STE 100
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City | BRYAN
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State | TX
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Zip | 77802-3499
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Country | US
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Telephone | 979-776-0169
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Fax | 979-776-1372
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Provider Business Mailing Address
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Address Line | 3121 UNIVERSITY DR E STE 100
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City | BRYAN
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State | TX
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Zip | 77802-3499
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Country | US
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Telephone | 979-776-0169
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Fax | 979-776-1372
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT0961
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1032357
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 1032357
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License Number State | TX
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