Provider Demographics
NPI:1417045147
Name:COOMBS, CANDICE D (DPT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:D
Last Name:COOMBS
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 1:12417 WINDERMERE LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20664-2206
Mailing Address - Country:US
Mailing Address - Phone:410-414-4791
Mailing Address - Fax:410-414-4765
Practice Address - Street 1:120 HOSPITAL ROAD AND CALVERT PHYSICAL THERAPY
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-414-4791
Practice Address - Fax:410-414-4765
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21687174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD606MMedicare ID - Type UnspecifiedMEDICARE