Provider Demographics
NPI:1992261994
Name:HENSON, CANDACE (DPT)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:726 S LYNN LANE RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74108-5118
Mailing Address - Country:US
Mailing Address - Phone:918-520-1620
Mailing Address - Fax:
Practice Address - Street 1:9709 E 79TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4566
Practice Address - Country:US
Practice Address - Phone:918-994-4000
Practice Address - Fax:918-994-4090
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist