MEDICARE: MR. JOSHUA MICK MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT22979	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336222652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSHUA MICK MPT

Provider Business Mailing Address
First Line	:	3801 E HIGHWAY 98
Second Line	:
City	:	PORT ST JOE
State	:	FL
Zip	:	32456-5318
Country	:	US
Telephone Number	:	850-229-5752
Fax Number	:	850-227-7999

Provider Business Practice Location Address
First Line	:	3801 E HIGHWAY 98
Second Line	:
City	:	PORT ST JOE
State	:	FL
Zip	:	32456-5318
Country	:	US
Telephone Number	:	850-229-5752
Fax Number	:	850-227-7999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	06/25/2013

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Directions to “ MR. JOSHUA MICK MPT” Practice Location

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