Provider Demographics
NPI:1568723997
Name:ST.JULIAN, CANDACE (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:ST.JULIAN
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WESTPORT PKWY
Mailing Address - Street 2:STE 140
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-5315
Mailing Address - Country:US
Mailing Address - Phone:817-693-2500
Mailing Address - Fax:
Practice Address - Street 1:2401 WESTPORT PKWY
Practice Address - Street 2:STE 140
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-5315
Practice Address - Country:US
Practice Address - Phone:817-693-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer