Basic Information
| Provider Information | |||||||||
| NPI: | 1518405489 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TIZZARD | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 HORSHAM RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | HORSHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190442140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154429060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 HORSHAM RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | HORSHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190442140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154429060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2017 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PT025846 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.