Provider Demographics
NPI:1659871184
Name:LACANDAZON, HECTOR ACUEZA (PT)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:ACUEZA
Last Name:LACANDAZON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19816 SCENIC HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1980
Mailing Address - Country:US
Mailing Address - Phone:248-231-8678
Mailing Address - Fax:
Practice Address - Street 1:28100 GRAND RIVER AVE STE 210
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5913
Practice Address - Country:US
Practice Address - Phone:248-471-8648
Practice Address - Fax:248-471-8781
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty