Candace Grace Raczkowski, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

9976 Issued in AZ

Practice address

2220 S Country Club Dr Ste 102
Mesa, AZ 85210-6808

Phone

(480) 633-8293

Fax

(480) 633-8293

NPI assigned

Sep 14, 2012

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 names 1

• Candace Grace Applebach Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1306196563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21300 N. JOHN WAYNE PARKWAY",
            "address_2": "SUITE 107",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851398964",
            "telephone_number": "520-868-6100",
            "fax_number": "520-868-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 S COUNTRY CLUB DR STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106808",
            "telephone_number": "480-633-8293",
            "fax_number": "480-633-8293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACZKOWSKI",
        "first_name": "CANDACE",
        "middle_name": "GRACE",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-14",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "9976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDACE",
            "last_name": "APPLEBACH",
            "middle_name": "GRACE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; 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.