Provider Demographics
NPI:1447232970
Name:ITO, CANDACE S (MPT)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:S
Last Name:ITO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11304 8TH AVE NE
Mailing Address - Street 2:STE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6111
Mailing Address - Country:US
Mailing Address - Phone:206-363-6184
Mailing Address - Fax:206-363-6543
Practice Address - Street 1:11304 8TH AVE NE
Practice Address - Street 2:STE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6111
Practice Address - Country:US
Practice Address - Phone:206-363-6184
Practice Address - Fax:206-363-6543
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005995225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA57231TOtherREGENCE BLUE SHIELD
WA1910872OtherFIRST HEALTH
WA0148998OtherLABOR AND INDUSTRIES