Provider Demographics
NPI:1841456274
Name:CANDILORA, CHARLES JAROD (CNMT, LMT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JAROD
Last Name:CANDILORA
Suffix:
Gender:M
Credentials:CNMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6844 S 500 E
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1347
Mailing Address - Country:US
Mailing Address - Phone:801-597-3113
Mailing Address - Fax:801-264-8361
Practice Address - Street 1:6844 S 500 E
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1347
Practice Address - Country:US
Practice Address - Phone:801-597-3113
Practice Address - Fax:801-264-8361
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6870286-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist