Provider Demographics
NPI:1790507846
Name:SABOL, CANDACE R (PTA)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:SABOL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:R
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 BUD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983-9517
Mailing Address - Country:US
Mailing Address - Phone:304-646-8522
Mailing Address - Fax:
Practice Address - Street 1:76 BUD RIDGE RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:WV
Practice Address - Zip Code:24983-9517
Practice Address - Country:US
Practice Address - Phone:304-646-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV446225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant