MEDICARE: KAREN STEPHANIE CANALES DPT

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	225100000X	Physical Therapist	40QA02288600	NJ

General Provider Information

NPI Number	:	1497582308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN STEPHANIE CANALES DPT

Provider Business Mailing Address
First Line	:	PO BOX 1102
Second Line	:
City	:	MOUNTAINSIDE
State	:	NJ
Zip	:	07092-0102
Country	:	US
Telephone Number	:	862-348-9515
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 ELM ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-2604
Country	:	US
Telephone Number	:	862-348-9515
Fax Number	:

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	01/13/2026

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