MEDICARE: MR. PAUL CANUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	8031A	AZ

General Provider Information

NPI Number	:	1215162243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL CANUP

Provider Business Mailing Address
First Line	:	3755 E BROADWAY RD
Second Line	:	#103
City	:	MESA
State	:	AZ
Zip	:	85206-1047
Country	:	US
Telephone Number	:	360-303-3163
Fax Number	:

Provider Business Practice Location Address
First Line	:	3755 E BROADWAY RD
Second Line	:	#103
City	:	MESA
State	:	AZ
Zip	:	85206-1047
Country	:	US
Telephone Number	:	360-303-3163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	05/19/2009

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Directions to “ MR. PAUL CANUP ” Practice Location

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