MEDICARE: CANDACE DELAP

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	225200000X	Physical Therapy Assistant	2009025849	MO

General Provider Information

NPI Number	:	1609137207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE DELAP

Provider Business Mailing Address
First Line	:	4401 N HANLEY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-2710
Country	:	US
Telephone Number	:	314-521-7471
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 N HANLEY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-2710
Country	:	US
Telephone Number	:	314-521-7471
Fax Number	:

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

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	05/31/2012

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Directions to “ CANDACE DELAP ” Practice Location

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