Provider Demographics
NPI:1588954663
Name:MOSTAD, JOEL D (DPT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:MOSTAD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 CLEARWATER WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6019
Mailing Address - Country:US
Mailing Address - Phone:859-553-6285
Mailing Address - Fax:
Practice Address - Street 1:2100 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2502
Practice Address - Country:US
Practice Address - Phone:859-260-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006037225100000X
TX1200459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist