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General NPI Number Information
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NPI Number | 1912554304
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Entity Type | Individual
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Provider Name | KIM MCCANDLESS
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Gender | Female
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 04/16/2022
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Provider Practice Location Address
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Address Line | 120 CYPRESS EDGE DR STE 101
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City | PALM COAST
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State | FL
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Zip | 32164-8454
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Country | US
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Telephone | 386-586-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 276 TIMBERWOOD DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-8388
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Country | US
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Telephone | 772-828-9230
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT34946
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License Number State | FL
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