Provider Demographics
NPI:1598979742
Name:MCCANDLESS, MELANIE RHEA (LCNMT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:RHEA
Last Name:MCCANDLESS
Suffix:
Gender:F
Credentials:LCNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 N HANCOCK AVE
Mailing Address - Street 2:SUITE 5 WEST
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2620
Mailing Address - Country:US
Mailing Address - Phone:719-577-9717
Mailing Address - Fax:
Practice Address - Street 1:1424 N HANCOCK AVE
Practice Address - Street 2:SUITE 5 WEST
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2620
Practice Address - Country:US
Practice Address - Phone:719-577-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO130367172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist