Provider Demographics
NPI:1881166320
Name:THOMAS, CANDACE D (PT, DPT)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:D
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5027 ATWOOD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8322
Mailing Address - Country:US
Mailing Address - Phone:859-625-0001
Mailing Address - Fax:859-625-0057
Practice Address - Street 1:3630 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1861
Practice Address - Country:US
Practice Address - Phone:502-749-6950
Practice Address - Fax:502-749-6953
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007566OtherPHYSICAL THERAPY LICENSE