Provider Demographics
NPI:1144743634
Name:WHERRY, CANDICE KRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:KRISTINE
Last Name:WHERRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:KRISTINE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:21 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1804
Mailing Address - Country:US
Mailing Address - Phone:413-364-1607
Mailing Address - Fax:
Practice Address - Street 1:360 BIRNIE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1104
Practice Address - Country:US
Practice Address - Phone:413-794-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist