Provider Demographics
NPI:1700330537
Name:NICHOLS, CANDISE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CANDISE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 E 37TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-3232
Mailing Address - Country:US
Mailing Address - Phone:316-854-2330
Mailing Address - Fax:316-681-0600
Practice Address - Street 1:6505 E 37TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-3232
Practice Address - Country:US
Practice Address - Phone:316-854-2330
Practice Address - Fax:316-681-0600
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist