MEDICARE: CANDACE CYNTHIA PHILLIPS PT, DPT

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	PT015308	GA

General Provider Information

NPI Number	:	1598333221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE CYNTHIA PHILLIPS PT, DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	3489 CHAMBLEE TUCKER RD STE E
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-4421
Country	:	US
Telephone Number	:	770-936-8025
Fax Number	:	770-936-9890

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

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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