Healthcare Provider Details

I. General information

NPI: 1063343002
Provider Name (Legal Business Name): JOSHUA CALDERWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 RIGBY LAKE DR STE 600
RIGBY ID
83442-5372
US

IV. Provider business mailing address

175 E 2ND N
RIGBY ID
83442-1232
US

V. Phone/Fax

Practice location:
  • Phone: 208-754-1210
  • Fax:
Mailing address:
  • Phone: 208-754-1210
  • Fax: 208-754-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: