Provider Demographics
NPI:1144328626
Name:EZELL, JOSHUA MATT (ATC)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:MATT
Last Name:EZELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 KEDZIE DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3372
Mailing Address - Country:US
Mailing Address - Phone:615-417-0675
Mailing Address - Fax:
Practice Address - Street 1:263 SEABOARD LN
Practice Address - Street 2:SUITE 200
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8245
Practice Address - Country:US
Practice Address - Phone:615-417-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000006412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer