Provider Demographics
NPI:1699068247
Name:PAGNOTTI, CANDICE (DPT)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:PAGNOTTI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:KILMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:CORPORATE OFFICE
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:570-343-7175
Mailing Address - Fax:570-343-7175
Practice Address - Street 1:1101 VINE ST
Practice Address - Street 2:THERAPY DEPT
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2126
Practice Address - Country:US
Practice Address - Phone:570-343-7175
Practice Address - Fax:570-343-7175
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist