Provider Demographics
NPI:1083198873
Name:LODGE, CANDA C (DPT)
Entity Type:Individual
Prefix:
First Name:CANDA
Middle Name:C
Last Name:LODGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 BENJAMIN ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2804
Mailing Address - Country:US
Mailing Address - Phone:541-357-3793
Mailing Address - Fax:
Practice Address - Street 1:2401 RIVER RD STE 102
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5412
Practice Address - Country:US
Practice Address - Phone:541-683-6187
Practice Address - Fax:541-689-4525
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42347225100000X
OR636852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist