Provider Demographics
NPI:1366915027
Name:HENDRICK, CANDISE NICHOLE (LMT)
Entity type:Individual
Prefix:
First Name:CANDISE
Middle Name:NICHOLE
Last Name:HENDRICK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 S COULTER ST APT 504
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-5421
Mailing Address - Country:US
Mailing Address - Phone:806-471-0826
Mailing Address - Fax:
Practice Address - Street 1:6666 W AMARILLO BLVD UNIT 1
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1752
Practice Address - Country:US
Practice Address - Phone:806-471-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107055225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist