Provider Demographics
NPI:1295043248
Name:PRATT, CANDIDA JILL (LMT)
Entity type:Individual
Prefix:MS
First Name:CANDIDA
Middle Name:JILL
Last Name:PRATT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 CLARENCE ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407
Mailing Address - Country:US
Mailing Address - Phone:850-235-9855
Mailing Address - Fax:
Practice Address - Street 1:10200 CLARENCE ST.
Practice Address - Street 2:SUITE B
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407
Practice Address - Country:US
Practice Address - Phone:850-235-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42093225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist