Columbus Candies, PT MPA/HA PH.D.

Key facts

NPI

1366701948

Entity type

Individual (NPI type 1)

Primary specialty

Orthopedic Physical Therapist 2251X0800X

License

1304798 (TX)

Practice address

1611 N Whitley Dr Ste 1a
Fruitland, ID 83619-2180

Phone

(208) 452-0021

Fax

(208) 452-0019

NPI assigned

May 16, 2012

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Philosophy

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 9, 2018.

{
    "created_epoch": "1337126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1366701948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 W SLAUGHTER LN",
            "address_2": "STE 300",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787481774",
            "telephone_number": "512-888-1201",
            "fax_number": "512-888-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 N WHITLEY DR STE 1A",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192180",
            "telephone_number": "208-452-0021",
            "fax_number": "208-452-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANDIES",
        "first_name": "COLUMBUS",
        "credential": "PT MPA/HA PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-16",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TX",
            "license": "1304798",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-1689",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fruitland, ID

• Buena Vista Enterprises, Inc.
• Paige Bunker
• Emily Burnett, AUD
• Terry A. Buster, M.S. LCPC, LMFT,LPC
• Nani Jane Cabrera, DO
• Canyon Idaho Home Care & Hospice, LLC
• Care at Home, Inc.
• Care Continuum, Inc.
• Cej Supply LLC
• Childrens Dentistry of Fruitland

All providers in Fruitland, ID · Orthopedic Physical Therapist in Idaho