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General NPI Number Information
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NPI Number | 1194591727
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Entity Type | Individual
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Provider Name | JOSHUA ALLAN ROBERTS
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Gender | Male
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 114 E COLUMBIA ST STE B5
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City | FARMINGTON
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State | MO
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Zip | 63640-3103
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Country | US
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Telephone | 573-952-9055
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Fax |
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Provider Business Mailing Address
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Address Line | 134 GARSON LN
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City | FARMINGTON
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State | MO
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Zip | 63640-7832
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Country | US
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Telephone | 573-952-9055
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2023004989
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License Number State | MO
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