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General NPI Number Information
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NPI Number | 1952775355
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Entity Type | Individual
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Provider Name | CANDICE VICTORIA BROCKEL DPT
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Gender | Female
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 3882 CENTRAL SARASOTA PKWY
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City | SARASOTA
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State | FL
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Zip | 34238-3046
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Country | US
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Telephone | 877-407-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 866-370-8206
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Fax | 517-435-3670
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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 | 40QA01646600
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License Number State | NJ
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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 | 11895
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License Number State | SC
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