Provider Demographics
NPI:1194121491
Name:SALLEY, JOSHUA (ATP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:SALLEY
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 RIFLE GAP RD APT 1126
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6487
Mailing Address - Country:US
Mailing Address - Phone:972-522-8559
Mailing Address - Fax:469-777-3447
Practice Address - Street 1:1545 CAPITAL DR STE 105
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3668
Practice Address - Country:US
Practice Address - Phone:972-434-1700
Practice Address - Fax:972-221-0099
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12094967OtherDRIVER'S LICENSE#