Provider Demographics
NPI:1518913359
Name:PELLA, CANDACE K (PT)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:K
Last Name:PELLA
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 1:500 OSBORNE RD NE STE 365
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2769
Mailing Address - Country:US
Mailing Address - Phone:763-236-2150
Mailing Address - Fax:637-236-2155
Practice Address - Street 1:500 OSBORNE RD NE STE 365
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2769
Practice Address - Country:US
Practice Address - Phone:763-236-2150
Practice Address - Fax:637-236-2155
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6405366OtherMEDICA
MN134G1PEOtherBLUE CROSS BLUE SHIELD
MN713523800Medicaid
MN125107OtherUCARE
MN936131043346OtherPREFERRED ONE
MNHP49410OtherHEALTH PARTNERS