| Doctor Name: | COLUMBUS CANDIES |
| NPI Number: | 1366701948 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT MPA/HA PH.D. |
| License Number: | PT-1689 |
| Business Practice Address: | 1611 N Whitley Dr Ste 1a Fruitland, ID - 836192180 |
| Business Phone Number: | 2084520021 |
| Business Fax Number: | 2084520019 |
| Mailing Address: | 1560 S Carol St, MERIDIAN |
| State: | ID |
| Postal Code: | 836461839 |
| Phone Number: | 2082879420 |
| Fax Number: | 2082879426 |
| NPI Enumeration Date: | 05/16/2012 |
| NPI Last Update Date: | 09/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT-1689 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |