Provider Demographics
NPI:1902163397
Name:SIMERLY, CANDACE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:
Last Name:SIMERLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CLINCHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1609
Mailing Address - Country:US
Mailing Address - Phone:423-743-1245
Mailing Address - Fax:423-743-2885
Practice Address - Street 1:800 S MOHAWK DR
Practice Address - Street 2:SUITE D
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-2124
Practice Address - Country:US
Practice Address - Phone:423-743-1245
Practice Address - Fax:423-743-2885
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000008875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist