Provider Demographics
NPI:1083856843
Name:SCOTTOW, CANDACE DALY (PT)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:DALY
Last Name:SCOTTOW
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 1:169 ASHLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-3500
Mailing Address - Country:US
Mailing Address - Phone:843-792-3481
Mailing Address - Fax:843-792-0724
Practice Address - Street 1:169 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-3500
Practice Address - Country:US
Practice Address - Phone:843-792-3481
Practice Address - Fax:843-792-0724
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist