Provider Demographics
NPI:1891961470
Name:CANDITO, PHILLIP JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:JOHN
Last Name:CANDITO
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 1:102 DAYL DR
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1208
Mailing Address - Country:US
Mailing Address - Phone:860-826-1696
Mailing Address - Fax:
Practice Address - Street 1:102 DAYL DR
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-1208
Practice Address - Country:US
Practice Address - Phone:860-826-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist