Provider Demographics
NPI:1588268635
Name:POWELL-ROMERO, CANDACE (DPT)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:POWELL-ROMERO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 5TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3154
Mailing Address - Country:US
Mailing Address - Phone:321-372-3090
Mailing Address - Fax:321-372-3097
Practice Address - Street 1:150 5TH AVE STE C
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3154
Practice Address - Country:US
Practice Address - Phone:321-372-3090
Practice Address - Fax:321-372-3097
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist