MEDICARE: MR. JOHN MCCANDLISH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	08047	OH

General Provider Information

NPI Number	:	1134195068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MCCANDLISH PT

Provider Business Mailing Address
First Line	:	2109 BROADWAY
Second Line	:	SUITE 204
City	:	NEW YORK
State	:	NY
Zip	:	10023-2106
Country	:	US
Telephone Number	:	212-799-0160
Fax Number	:

Provider Business Practice Location Address
First Line	:	2109 BROADWAY
Second Line	:	SUITE 204
City	:	NEW YORK
State	:	NY
Zip	:	10023-2106
Country	:	US
Telephone Number	:	212-799-0160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	11/08/2007

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Directions to “ MR. JOHN MCCANDLISH PT” Practice Location

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