Provider Demographics
NPI:1306196563
Name:RACZKOWSKI, CANDACE GRACE (PT)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:GRACE
Last Name:RACZKOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:GRACE
Other - Last Name:APPLEBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21300 N. JOHN WAYNE PARKWAY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-8964
Mailing Address - Country:US
Mailing Address - Phone:520-868-6100
Mailing Address - Fax:520-868-6106
Practice Address - Street 1:2220 S COUNTRY CLUB DR STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6808
Practice Address - Country:US
Practice Address - Phone:480-633-8293
Practice Address - Fax:480-633-8293
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist