Provider Demographics
NPI:1225673775
Name:CANDIES, CAMERON ROYCE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:ROYCE
Last Name:CANDIES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 RIDGEVIEW LOOP SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-1443
Mailing Address - Country:US
Mailing Address - Phone:208-477-3008
Mailing Address - Fax:
Practice Address - Street 1:19510 VENTURA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2974
Practice Address - Country:US
Practice Address - Phone:818-996-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist