Provider Demographics
NPI:1487797841
Name:DIPASQUALE, CANDICE JOY (ATC)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:JOY
Last Name:DIPASQUALE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EAST MUDPIKE RD.
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15530
Mailing Address - Country:US
Mailing Address - Phone:814-233-0601
Mailing Address - Fax:
Practice Address - Street 1:4201 GLADES PIKE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1144
Practice Address - Country:US
Practice Address - Phone:814-445-7727
Practice Address - Fax:814-445-7012
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0032382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer