Basic Information
| Provider Information | |||||||||
| NPI: | 1972254894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VICTOR | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 NORTH JUNIATA STREET | ||||||||
| Address2: | STE A | ||||||||
| City: | LEWISTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179539643 | ||||||||
| FaxNumber: | 7179539661 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 NORTH JUNIATA STREET | ||||||||
| Address2: | STE A | ||||||||
| City: | LEWISTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179539643 | ||||||||
| FaxNumber: | 7179539661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2022 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.