Provider Demographics
NPI:1851613624
Name:MICHELSON, CANDICE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:MICHELSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 W 187TH PL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5831
Mailing Address - Country:US
Mailing Address - Phone:310-999-1937
Mailing Address - Fax:310-327-2406
Practice Address - Street 1:1247 MILL BAY RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6409
Practice Address - Country:US
Practice Address - Phone:907-486-9515
Practice Address - Fax:907-486-9516
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160922251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics