Provider Demographics
NPI:1750428033
Name:PLEMONS, JOSHUA D
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:D
Last Name:PLEMONS
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 1:2725 WATER RIDGE PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4581
Mailing Address - Country:US
Mailing Address - Phone:704-831-5065
Mailing Address - Fax:704-831-5066
Practice Address - Street 1:2725 WATER RIDGE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-4580
Practice Address - Country:US
Practice Address - Phone:704-831-5065
Practice Address - Fax:704-831-5066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3178225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3656877Medicare PIN
TN3734647Medicare PIN