Provider Demographics
NPI:1083752083
Name:CANDIDO, LILIE MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:LILIE
Middle Name:MARIE
Last Name:CANDIDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1262
Mailing Address - Country:US
Mailing Address - Phone:573-301-4748
Mailing Address - Fax:
Practice Address - Street 1:21 LUTHER LN
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-1914
Practice Address - Country:US
Practice Address - Phone:573-301-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist