Provider Demographics
NPI:1912309303
Name:MCCANDLESS, CASSIE JO (DPT)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:JO
Last Name:MCCANDLESS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:
Practice Address - Street 1:2040 HUTTON RD STE 104
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4566
Practice Address - Country:US
Practice Address - Phone:913-725-8340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3833225100000X
SC7430225100000X
KS11-07165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist