Provider Demographics
NPI:1760690564
Name:PARHAM, CANDACE S (MS, VATL, ATC)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:S
Last Name:PARHAM
Suffix:
Gender:F
Credentials:MS, VATL, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13107 AUTUMN WOODS WAY
Mailing Address - Street 2:APT. F
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5020
Mailing Address - Country:US
Mailing Address - Phone:703-803-2909
Mailing Address - Fax:
Practice Address - Street 1:10900 UNIVERSITY BLVD
Practice Address - Street 2:MS 4E5
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2201
Practice Address - Country:US
Practice Address - Phone:703-993-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260008182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer