Healthcare Provider Details

I. General information

NPI: 1699964254
Provider Name (Legal Business Name): LADY CECILLE CANETE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4377 BRONX BLVD
BRONX NY
10466-1397
US

IV. Provider business mailing address

5454 EIDER TRL
FORT WAYNE IN
46818-0102
US

V. Phone/Fax

Practice location:
  • Phone: 718-325-0700
  • Fax:
Mailing address:
  • Phone: 917-385-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberP61241
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62 031409
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05010278A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: