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General NPI Number Information
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NPI Number | 1487797841
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Entity Type | Individual
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Provider Name | CANDICE JOY DIPASQUALE ATC
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4201 GLADES PIKE
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City | SOMERSET
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State | PA
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Zip | 15501-1144
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Country | US
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Telephone | 814-445-7727
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Fax | 814-445-7012
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Provider Business Mailing Address
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Address Line | 1400 EAST MUDPIKE RD.
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City | BERLIN
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State | PA
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Zip | 15530
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Country | US
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Telephone | 814-233-0601
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT003238
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License Number State | PA
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