Provider Demographics
NPI:1366701948
Name:CANDIES, COLUMBUS (PT MPA/HA PHD)
Entity type:Individual
Prefix:
First Name:COLUMBUS
Middle Name:
Last Name:CANDIES
Suffix:
Gender:M
Credentials:PT MPA/HA PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W SLAUGHTER LN
Mailing Address - Street 2:STE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1774
Mailing Address - Country:US
Mailing Address - Phone:512-888-1201
Mailing Address - Fax:512-888-1202
Practice Address - Street 1:1611 N WHITLEY DR STE 1A
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2180
Practice Address - Country:US
Practice Address - Phone:208-452-0021
Practice Address - Fax:208-452-0019
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13047982251X0800X
IDPT-1689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist