Provider Demographics
NPI:1255837043
Name:REYNOLDS, CANDICE LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:LAUREN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 READING RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-4839
Mailing Address - Country:US
Mailing Address - Phone:513-733-3370
Mailing Address - Fax:513-786-7893
Practice Address - Street 1:8781 CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3136
Practice Address - Country:US
Practice Address - Phone:513-733-3370
Practice Address - Fax:513-786-7893
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH012669OtherLICENSE