Provider Demographics
NPI:1699505784
Name:STURGILL, JOSHUA COLE
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:COLE
Last Name:STURGILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 HEADLEE AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2672
Mailing Address - Country:US
Mailing Address - Phone:304-490-9723
Mailing Address - Fax:
Practice Address - Street 1:1343 HEADLEE AVE APT 12
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2672
Practice Address - Country:US
Practice Address - Phone:304-490-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002973225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty