Active NPI
Candace Rebecca Latshaw, D.P.T.
- Physical Therapist
- Grand Rapids, MI
National Provider Identifier
1205260783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501016453
- Practice address
- 1401 Cedar St NE
Grand Rapids, MI 49503-1375 - Phone
- (616) 260-6637
- NPI assigned
- Sep 3, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501016453 | MI | Primary |
Addresses
Primary practice location
1401 Cedar St NE
Grand Rapids, MI 49503-1375
Mailing address
5567 Whitneyville Ave SE
Alto, MI 49302-9704
Phone (734) 904-1804
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501016453 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520380800000",
"number": "1205260783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5567 WHITNEYVILLE AVE SE",
"city": "ALTO",
"state": "MI",
"postal_code": "493029704",
"telephone_number": "734-904-1804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 CEDAR ST NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495031375",
"telephone_number": "616-260-6637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LATSHAW",
"first_name": "CANDACE",
"middle_name": "REBECCA",
"name_prefix": "Dr.",
"credential": "D.P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-03",
"last_updated": "2018-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501016453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.