Active NPI
Candice Lynn Bronaugh, LMT, PTA
- Physical Therapy Assistant
- Magnolia, TX
National Provider Identifier
1366747727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2182567
- Practice address
- 31235 Edgewater Dr
Magnolia, TX 77354-6238 - Phone
- (979) 900-0830
- NPI assigned
- Jan 17, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT111469 | TX | |
| Physical Therapy Assistant | 225200000X | 2182567 | TX | Primary |
Addresses
Primary practice location
31235 Edgewater Dr
Magnolia, TX 77354-6238
Mailing address
31235 Edgewater Dr
Magnolia, TX 77354-6238
Phone (979) 900-0830
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 |
|---|---|---|---|
| 2182567 | TX | MD | Physical Therapy Assistant |
| MT111469 | TX | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732406400000",
"number": "1366747727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31235 EDGEWATER DR",
"city": "MAGNOLIA",
"state": "TX",
"postal_code": "773546238",
"telephone_number": "979-900-0830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31235 EDGEWATER DR",
"city": "MAGNOLIA",
"state": "TX",
"postal_code": "773546238",
"telephone_number": "979-900-0830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRONAUGH",
"first_name": "CANDICE",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "LMT, PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-17",
"last_updated": "2024-11-24",
"certification_date": "2024-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TX",
"license": "MT111469",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2182567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Magnolia, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.