Provider Demographics
NPI:1104471598
Name:KLEM, JOSHUA JORDAN (PT DPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JORDAN
Last Name:KLEM
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 COLIBRI LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4303
Mailing Address - Country:US
Mailing Address - Phone:530-368-0782
Mailing Address - Fax:
Practice Address - Street 1:1922 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6024
Practice Address - Country:US
Practice Address - Phone:760-295-4175
Practice Address - Fax:760-295-4176
Is Sole Proprietor?:No
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist