Healthcare Provider Details

I. General information

NPI: 1932038650
Provider Name (Legal Business Name): CANDACE J MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W DUNCAN AVE
FLORENCE AL
35630-2110
US

IV. Provider business mailing address

128 W DUNCAN AVE
FLORENCE AL
35630-2110
US

V. Phone/Fax

Practice location:
  • Phone: 256-483-8531
  • Fax:
Mailing address:
  • Phone: 256-483-8531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number2002356
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: