Provider Demographics
NPI:1063409092
Name:YOCUM, JOSHUA LANE (PT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LANE
Last Name:YOCUM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 BRUCE RD
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-5233
Mailing Address - Country:US
Mailing Address - Phone:804-238-4860
Mailing Address - Fax:
Practice Address - Street 1:4301 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3305
Practice Address - Country:US
Practice Address - Phone:804-358-0361
Practice Address - Fax:804-358-4286
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009402331Medicaid
VA20091OtherSENTARA
VA009402331Medicaid
GA002508C78Medicare ID - Type UnspecifiedRAILROAD MEDICARE PART B