Provider Demographics
NPI:1992381701
Name:ARTYM, CANDACE MAIA (PTA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MAIA
Last Name:ARTYM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:MAIA
Other - Last Name:ARTYM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5205 BLUE IVY
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2380
Mailing Address - Country:US
Mailing Address - Phone:417-825-5008
Mailing Address - Fax:
Practice Address - Street 1:305 NE LOOP 820
Practice Address - Street 2:BUSINESS TOWER 1 SUITE 200
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-1286
Practice Address - Country:US
Practice Address - Phone:817-292-8787
Practice Address - Fax:817-789-6849
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2160566225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant