Provider Demographics
NPI:1881740777
Name:CALANDRA, JOSEPH C (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:CALANDRA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 LETICIA CT
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-7560
Mailing Address - Country:US
Mailing Address - Phone:801-898-5050
Mailing Address - Fax:801-969-3885
Practice Address - Street 1:5406 LETICIA CT
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-7560
Practice Address - Country:US
Practice Address - Phone:801-898-5050
Practice Address - Fax:801-969-3885
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275372-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTHT001363002OtherMOLINA
UTP00278853OtherRAILROAD MEDICARE
UTHT001363002OtherMOLINA
UT$$$$$$$$$03001OtherBCBS MEDADVANTAGE
UT005744501Medicare PIN