Provider Demographics
NPI:1255498929
Name:GODWIN, CANDACE S (MPT)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:S
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1411
Mailing Address - Country:US
Mailing Address - Phone:303-541-9090
Mailing Address - Fax:
Practice Address - Street 1:3300 28TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1411
Practice Address - Country:US
Practice Address - Phone:303-541-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008929225100000X
COPTL.0011938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist