Healthcare Provider Details

I. General information

NPI: 1710534052
Provider Name (Legal Business Name): CATHRYN MCCANDLESS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9852 BUSINESS PARK DR
SACRAMENTO CA
95827-1709
US

IV. Provider business mailing address

5650 8TH AVE
SACRAMENTO CA
95820-1724
US

V. Phone/Fax

Practice location:
  • Phone: 916-362-7962
  • Fax:
Mailing address:
  • Phone: 209-602-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number297250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: