Provider Demographics
NPI:1154955664
Name:LILLIBRIDGE, CANDACE L (PT)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:L
Last Name:LILLIBRIDGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W BROOKLAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3208
Mailing Address - Country:US
Mailing Address - Phone:281-558-9626
Mailing Address - Fax:
Practice Address - Street 1:700 TOWN & COUNTRY BLVD
Practice Address - Street 2:SUITE 2490
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:832-658-3150
Practice Address - Fax:713-722-7051
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1060820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty