Basic Information
| Provider Information | |||||||||
| NPI: | 1891081162 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERSHEIM | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3455 HIGHWAY 81 SOUTH | ||||||||
| Address2: | |||||||||
| City: | LOGANVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300523918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705540665 | ||||||||
| FaxNumber: | 7705540685 | ||||||||
| Practice Location | |||||||||
| Address1: | 54 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | WEYERS CAVE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244862340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402348800 | ||||||||
| FaxNumber: | 5402348939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2011 | ||||||||
| LastUpdateDate: | 04/26/2017 | ||||||||
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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 | 225100000X | 2305206965 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.