Provider Demographics
NPI:1336496868
Name:LYTTON, KANDICE MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:KANDICE
Middle Name:MARIE
Last Name:LYTTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KANDICE
Other - Middle Name:MARIE
Other - Last Name:LESOFSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1790
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-1790
Mailing Address - Country:US
Mailing Address - Phone:307-359-7700
Mailing Address - Fax:
Practice Address - Street 1:469 S MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2535
Practice Address - Country:US
Practice Address - Phone:307-754-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9048225100000X
WY1827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist