Provider Demographics
NPI:1306339130
Name:REINHARDT, CANDACE NOEL (LMT)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:NOEL
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:NOEL
Other - Last Name:REINHARDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:631 JASON ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2750
Mailing Address - Country:US
Mailing Address - Phone:971-273-0084
Mailing Address - Fax:
Practice Address - Street 1:631 JASON ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:971-273-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22322225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist