Provider Demographics
NPI:1932307956
Name:DOMANN, CANDACE (ATC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:DOMANN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CANTERBURY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 CANTERBURY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2247
Practice Address - Country:US
Practice Address - Phone:785-623-6368
Practice Address - Fax:785-623-5676
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-002682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer