Columbus Candies, PT MPA/HA PH.D.

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

1304798 Issued in 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

Last updated

Oct 9, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "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": []
}

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• Orthopedic Physical Therapist in Fruitland, ID
• Providers in Fruitland, ID by specialty
• Orthopedic Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.

Verify at the official NPI Registry.