Candice Lea Van Iderstine, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

14653 Issued in MD

Practice address

15003 Health Center Dr
Bowie, MD 20716-1017

Phone

(301) 809-2090

Fax

(301) 809-2034

NPI assigned

Sep 12, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dimensions Health Corporation

  • Physical Therapy Clinic/Center
  • Bowie, MD
  • NPI 1669584504
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174627798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3536 JAMESTOWN RD",
            "city": "DAVIDSONVILLE",
            "state": "MD",
            "postal_code": "210352011",
            "telephone_number": "410-798-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15003 HEALTH CENTER DR",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207161017",
            "telephone_number": "301-809-2090",
            "fax_number": "301-809-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN IDERSTINE",
        "first_name": "CANDICE",
        "middle_name": "LEA",
        "name_prefix": "Ms.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "14653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO PROVIDER NUMBER",
            "identifier": "7082461",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MARYLAND GROUP 6",
            "identifier": "KFK1",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI PROVIDER NUMBER",
            "identifier": "2142926",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO PROVIDER #",
            "identifier": "3346568",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF DC GROUPG719",
            "identifier": "0001",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• V&T Health Service
• Jeel Vaddoriya
• Emma H Vaillant, BCBA
• Letha Valiaveedu, LPC
• Helga Van Dolsen, C.R.N.P.
• Catherine S Vanderhoef, LMT
• Eduardo Vargas
• Sophy Mary Varghese
• Varsity Professional Rehabilitation and Staffing, LLC
• Priya Vasdev, M.D.

• Physical Therapist in Bowie, MD
• Providers in Bowie, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.