MEDICARE: MRS. DEBBIE F CANOA 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	16344	MA

General Provider Information

NPI Number	:	1679568950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBBIE F CANOA DPT

Provider Business Mailing Address
First Line	:	45 FRANCIS ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-6105
Country	:	US
Telephone Number	:	617-732-5304
Fax Number	:	617-730-2884

Provider Business Practice Location Address
First Line	:	45 FRANCIS ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-6105
Country	:	US
Telephone Number	:	617-732-5304
Fax Number	:	617-730-2884

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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