Provider Demographics
NPI:1679979611
Name:METCALF, CANDACE NICOLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:NICOLE
Last Name:METCALF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 MEYERS BAKER RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3006
Mailing Address - Country:US
Mailing Address - Phone:606-864-7316
Mailing Address - Fax:606-878-0590
Practice Address - Street 1:649 MEYERS BAKER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3006
Practice Address - Country:US
Practice Address - Phone:606-864-7316
Practice Address - Fax:606-878-0590
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist