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General NPI Number Information
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NPI Number | 1508619347
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Entity Type | Individual
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Provider Name | JOSHUA GLEN WOOLSTENHULME PT, DPT, PHD, LAMFT
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Gender | Male
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 1510 W USTICK RD STE 110
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City | MERIDIAN
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State | ID
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Zip | 83646-7740
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Country | US
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Telephone | 208-520-0752
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 NW 12TH AVE
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City | MERIDIAN
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State | ID
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Zip | 83646-6796
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Country | US
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Telephone | 208-520-0752
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-2303
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LAMFT-9985
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License Number State | ID
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