Provider Demographics
NPI:1356578488
Name:MOODY, CANDICE NICHOLE (DPT)
Entity type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:NICHOLE
Last Name:MOODY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:NICHOLE
Other - Last Name:CHEFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:585 MERCER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321
Mailing Address - Country:US
Mailing Address - Phone:423-775-7101
Mailing Address - Fax:423-775-7103
Practice Address - Street 1:585 MERCER DRIVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321
Practice Address - Country:US
Practice Address - Phone:423-775-7101
Practice Address - Fax:423-775-7103
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT8374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist