Healthcare Provider Details

I. General information

NPI: 1780362467
Provider Name (Legal Business Name): MONICA DIONISIO CANLAS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 09/27/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E PUTNAM AVE 2ND FLOOR,
OLD GREENWICH CT
06870
US

IV. Provider business mailing address

1455 E PUTNAM AVE 2ND FLOOR,
OLD GREENWICH CT
06870
US

V. Phone/Fax

Practice location:
  • Phone: 203-817-0196
  • Fax:
Mailing address:
  • Phone: 203-817-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05060101
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13874
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: