Provider Demographics
NPI:1417210535
Name:NEWBURY, CANDICE J (PT)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:J
Last Name:NEWBURY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NICHOLS ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IN
Mailing Address - Zip Code:46341-8774
Mailing Address - Country:US
Mailing Address - Phone:219-996-5695
Mailing Address - Fax:219-996-5635
Practice Address - Street 1:6678 US HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5117
Practice Address - Country:US
Practice Address - Phone:219-762-0821
Practice Address - Fax:219-763-3637
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010441A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist