Provider Demographics
NPI:1508619347
Name:WOOLSTENHULME, JOSHUA GLEN (PT, DPT, PHD, LAMFT)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:GLEN
Last Name:WOOLSTENHULME
Suffix:
Gender:M
Credentials:PT, DPT, PHD, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6796
Mailing Address - Country:US
Mailing Address - Phone:208-520-0752
Mailing Address - Fax:
Practice Address - Street 1:1510 W USTICK RD STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7740
Practice Address - Country:US
Practice Address - Phone:208-520-0752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2303225100000X
IDLAMFT-9985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist