Kim McCandless

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT34946 Issued in FL

Practice address

120 Cypress Edge Dr Ste 101
Palm Coast, FL 32164-8454

Phone

(386) 586-1670

NPI assigned

Aug 21, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Memorial Hospital Flagler Inc

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1679678486
  NPD (past)

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

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650067200000",
    "number": "1912554304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 TIMBERWOOD DR",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320848388",
            "telephone_number": "772-828-9230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 CYPRESS EDGE DR STE 101",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321648454",
            "telephone_number": "386-586-1670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCANDLESS",
        "first_name": "KIM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-21",
        "last_updated": "2022-04-16",
        "certification_date": "2022-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "FL",
            "license": "PT34946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alison Mazzatelli, DPT
• Dianne Lynne Mazzo, ARNP
• Bernard Mballesube, PHARM.D
• Ladana Shareice Mboup
• Aynne McAvoy
• John P. McCarthy, M.D.
• Malik McCarthy
• Yaasmiin McClain
• Maureen A McClernon, PT
• Christopher Duke McClure, H.A.S.

• Pediatric Physical Therapist in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Pediatric Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2022; 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.