Provider Demographics
NPI:1881805109
Name:CREELMAN, JAMES E III (DPT)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:CREELMAN
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 W BUELL ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-2558
Mailing Address - Country:US
Mailing Address - Phone:208-282-4566
Mailing Address - Fax:208-282-4962
Practice Address - Street 1:IDAHO STATE UNIVERSITY
Practice Address - Street 2:CAMPUS BOX 8045
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-0001
Practice Address - Country:US
Practice Address - Phone:208-282-4566
Practice Address - Fax:208-282-4962
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist