Healthcare Provider Details

I. General information

NPI: 1982908190
Provider Name (Legal Business Name): CANDICE GOOD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDICE SCOTT PT

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W. COLORADO AVE UNIT 2B
TELLURIDE CO
81435-3178
US

IV. Provider business mailing address

P.O. BOX 3178
TELLURIDE CO
81435-3178
US

V. Phone/Fax

Practice location:
  • Phone: 970-728-1888
  • Fax: 970-369-4671
Mailing address:
  • Phone: 970-728-1888
  • Fax: 970-369-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number6777
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number6777
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: