Provider Demographics
NPI:1417646407
Name:CANDA LODGE DPT LLC
Entity Type:Organization
Organization Name:CANDA LODGE DPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-357-3793
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 1:356 BENJAMIN ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2804
Practice Address - Country:US
Practice Address - Phone:541-357-3793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty