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General NPI Number Information
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NPI Number | 1336496868
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Entity Type | Individual
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Provider Name | KANDICE MARIE LYTTON PT
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Gender | Female
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 469 S MOUNTAIN VIEW ST
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City | POWELL
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State | WY
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Zip | 82435-2535
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Country | US
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Telephone | 307-754-1235
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1790
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City | DOUGLAS
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State | WY
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Zip | 82633-1790
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Country | US
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Telephone | 307-359-7700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9048
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1827
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License Number State | WY
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