MEDICARE: MICHAEL J CANDITO PT

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	11955	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y68511	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1184686321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J CANDITO PT

Provider Business Mailing Address
First Line	:	703 GRANITE ST
Second Line	:	3RD FLR
City	:	BRAINTREE
State	:	MA
Zip	:	02184-5350
Country	:	US
Telephone Number	:	781-961-3370
Fax Number	:	781-961-1291

Provider Business Practice Location Address
First Line	:	306A HIGH ST
Second Line	:
City	:	GREENFIELD
State	:	MA
Zip	:	01301-2611
Country	:	US
Telephone Number	:	413-773-3379
Fax Number	:	413-776-5050

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	04/19/2021

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