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General NPI Number Information
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NPI Number | 1750813762
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Entity Type | Individual
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Provider Name | JOSHUA MILTENBERGER LMT
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Gender | Male
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 2200 BROADWAY ST STE A
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City | VANCOUVER
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State | WA
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Zip | 98663-3255
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Country | US
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Telephone | 360-844-0896
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Fax |
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Provider Business Mailing Address
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Address Line | 11900 NE 18TH ST EA514
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City | VANCOUVER
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State | WA
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Zip | 98684-4886
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Country | US
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Telephone |
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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 | MA 60735769
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 023153
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License Number State | OR
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