Provider Demographics
NPI:1568652683
Name:WRIGHT, CANDACE M (PT)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CANDACE
Other - Middle Name:M
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:310 MID-CONTINENT PLAZA
Mailing Address - Street 2:SUITE 185
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-1700
Mailing Address - Country:US
Mailing Address - Phone:870-732-2828
Mailing Address - Fax:870-732-1727
Practice Address - Street 1:310 MID-CONTINENT PLAZA
Practice Address - Street 2:SUITE 185
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1700
Practice Address - Country:US
Practice Address - Phone:870-732-2828
Practice Address - Fax:870-732-1727
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164771721Medicaid