Provider Demographics
NPI:1699017517
Name:LOVE, CANDACE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MARIE
Last Name:LOVE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16269 LAGUNA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3603
Mailing Address - Country:US
Mailing Address - Phone:949-788-9236
Mailing Address - Fax:949-861-6595
Practice Address - Street 1:16269 LAGUNA CANYON RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3603
Practice Address - Country:US
Practice Address - Phone:949-788-9236
Practice Address - Fax:949-861-6595
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 40020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHJ201ZMedicare PIN