Provider Demographics
NPI:1982908190
Name:GOOD, CANDICE (PT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:GOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:P.O. BOX 3178
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-3178
Mailing Address - Country:US
Mailing Address - Phone:970-728-1888
Mailing Address - Fax:970-369-4671
Practice Address - Street 1:300 W. COLORADO AVE
Practice Address - Street 2:UNIT 2B
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-3178
Practice Address - Country:US
Practice Address - Phone:970-728-1888
Practice Address - Fax:970-369-4671
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO67772251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports