Healthcare Provider Details

I. General information

NPI: 1093642894
Provider Name (Legal Business Name): NICHOLAS SHANE CANFIELD DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 HIGHWAY 72
KILLEN AL
35645
US

IV. Provider business mailing address

203 NARROWS PKWY STE D
BIRMINGHAM AL
35242-8649
US

V. Phone/Fax

Practice location:
  • Phone: 256-938-8010
  • Fax: 256-938-8020
Mailing address:
  • Phone: 256-938-8010
  • Fax: 256-938-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH12652
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: