Provider Demographics
NPI:1215020243
Name:WALHOOD, CANDACE LYN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LYN
Last Name:WALHOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CANDACE
Other - Middle Name:LYN
Other - Last Name:MURHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7685 SW 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7029
Mailing Address - Country:US
Mailing Address - Phone:503-245-8300
Mailing Address - Fax:
Practice Address - Street 1:25117 SW PARKWAY AVE
Practice Address - Street 2:STE.D
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9697
Practice Address - Country:US
Practice Address - Phone:503-570-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0333225100000X
WAPT00002325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist