Healthcare Provider Details

I. General information

NPI: 1487792461
Provider Name (Legal Business Name): WILFREDO CANALES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 NW 107TH AVE STE 101
SWEETWATER FL
33172-2739
US

IV. Provider business mailing address

1301 NE MIAMI GARDENS DR APT 1525
MIAMI GARDENS FL
33179-4994
US

V. Phone/Fax

Practice location:
  • Phone: 305-640-8675
  • Fax: 305-414-2990
Mailing address:
  • Phone: 305-333-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: