Provider Demographics
NPI:1194792440
Name:WELLENSTEIN, JOSHUA EARL (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:EARL
Last Name:WELLENSTEIN
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 1:21 GREGORY DR
Mailing Address - Street 2:C/O POULIN PERFORMANCE, INC.
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6080
Mailing Address - Country:US
Mailing Address - Phone:802-658-0949
Mailing Address - Fax:802-658-1436
Practice Address - Street 1:21 GREGORY DR
Practice Address - Street 2:C/O POULIN PERFORMANCE, INC.
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6080
Practice Address - Country:US
Practice Address - Phone:802-658-0949
Practice Address - Fax:802-658-1436
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0226101225100000X
VT04000610312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10064961OtherCDPHP
10064961OtherCDPHP