Provider Demographics
NPI:1598898298
Name:REEVES, CANDICE LORIEL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:LORIEL
Last Name:REEVES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-2058
Mailing Address - Country:US
Mailing Address - Phone:573-336-8991
Mailing Address - Fax:573-336-8993
Practice Address - Street 1:413 SMITH RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-2058
Practice Address - Country:US
Practice Address - Phone:573-336-8991
Practice Address - Fax:573-336-8993
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003031075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist