Provider Demographics
NPI:1437415908
Name:LOW, CANDACE JEAN (ATC, MED)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:JEAN
Last Name:LOW
Suffix:
Gender:F
Credentials:ATC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98830-0313
Mailing Address - Country:US
Mailing Address - Phone:208-404-6130
Mailing Address - Fax:
Practice Address - Street 1:31 W. 1ST AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:WA
Practice Address - Zip Code:98830-0313
Practice Address - Country:US
Practice Address - Phone:208-404-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer