Provider Demographics
NPI:1609488303
Name:CALHOUN, SPENCER REID (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:REID
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 E RIVERSIDE DR APT P308
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7573
Mailing Address - Country:US
Mailing Address - Phone:912-675-8944
Mailing Address - Fax:
Practice Address - Street 1:2411 E RIVERSIDE DR APT P308
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7573
Practice Address - Country:US
Practice Address - Phone:912-675-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-6977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist