Provider Demographics
NPI:1255776399
Name:BARRETTA, CANDACE A Y (PT)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:A Y
Last Name:BARRETTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:YONASHIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:95-1086 EULU ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3725
Mailing Address - Country:US
Mailing Address - Phone:808-487-0487
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE 207
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3925
Practice Address - Country:US
Practice Address - Phone:808-487-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPT3661OtherLICENSE