Provider Demographics
NPI:1962969550
Name:COLLIE, CANDACE S
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:S
Last Name:COLLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 WILLIAMS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-8022
Mailing Address - Country:US
Mailing Address - Phone:828-773-4377
Mailing Address - Fax:
Practice Address - Street 1:247 WILLIAMS RIDGE RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8022
Practice Address - Country:US
Practice Address - Phone:828-773-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist