Provider Demographics
NPI:1407022353
Name:BRIONES, CANDICE LAURETA (PT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:LAURETA
Last Name:BRIONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 ENGLE RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5386
Mailing Address - Country:US
Mailing Address - Phone:630-660-9266
Mailing Address - Fax:
Practice Address - Street 1:1201 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3718
Practice Address - Country:US
Practice Address - Phone:815-725-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.013068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist