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NPI Code Detail

MEDICARE: JOSHUA S. FANGMAN PT, DPT

MEDICARE: JOSHUA S. FANGMAN PT, DPT
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
1225100000XPhysical Therapist12730-24WI

General Provider Information

NPI Number : 1386056869
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA S. FANGMAN PT, DPT
Provider Business Mailing Address
First Line : 3048 MOMENTUM PL
Second Line :
City : CHICAGO
State : IL
Zip : 60689-5330
Country : US
Telephone Number : 262-657-0222
Fax Number : 262-657-7190
Provider Business Practice Location Address
First Line : 25250 75TH ST
Second Line :
City : SALEM
State : WI
Zip : 53168-8705
Country : US
Telephone Number : 262-843-4200
Fax Number : 262-843-4578
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2014
Last Update Date : 12/05/2015

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