Provider Demographics
NPI:1215272281
Name:CANDOLEA, REYNALDO D (PT,GCS)
Entity type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:D
Last Name:CANDOLEA
Suffix:
Gender:M
Credentials:PT,GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1703
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1703
Mailing Address - Country:US
Mailing Address - Phone:727-786-4403
Mailing Address - Fax:727-786-4403
Practice Address - Street 1:3865 OLDSMAR RD.
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677
Practice Address - Country:US
Practice Address - Phone:813-855-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 5588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist