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General NPI Number Information
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NPI Number | 1629558408
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Entity Type | Individual
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Provider Name | JOSHUA SPECKMAN
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Gender | Male
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 2119 CLIFF RD
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City | EAGAN
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State | MN
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Zip | 55122-2345
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Country | US
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Telephone | 612-978-7497
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Fax |
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Provider Business Mailing Address
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Address Line | 2708 E 22ND ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55406-1315
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Country | US
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Telephone | 612-978-7497
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 11229
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License Number State | MN
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