MEDICARE: JOSHUA JOHN PITTERLE

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	225700000X	Massage Therapist	MT-27743	AZ

General Provider Information

NPI Number	:	1467288258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA JOHN PITTERLE

Provider Business Mailing Address
First Line	:	5183 N DESERT LN
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-9317
Country	:	US
Telephone Number	:	480-323-8588
Fax Number	:

Provider Business Practice Location Address
First Line	:	7749 E FLORENTINE RD STE B
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-1205
Country	:	US
Telephone Number	:	928-772-7200
Fax Number	:

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

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	09/10/2024

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Directions to “ JOSHUA JOHN PITTERLE ” Practice Location

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