MEDICARE: JOSEPH C CALANDRA P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	275372-2401	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00278853	OTHER	UT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HT001363002	OTHER	UT	MOLINA

General Provider Information

NPI Number	:	1881740777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH C CALANDRA P.T.

Provider Business Mailing Address
First Line	:	5406 LETICIA CT
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-7560
Country	:	US
Telephone Number	:	801-898-5050
Fax Number	:	801-969-3885

Provider Business Practice Location Address
First Line	:	5406 LETICIA CT
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-7560
Country	:	US
Telephone Number	:	801-898-5050
Fax Number	:	801-969-3885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	01/08/2013

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