Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 297294 | CA |
NPI | 1063060812 |
---|---|
Provider Name | Candace Marie Edwards |
First Address | Carmichael, CA 95608-3331 |
Second Address | Fair Oaks, CA 95628-3131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2019 |
Last Update Date | 26/08/2019 |