Provider Demographics
NPI:1144388836
Name:CANITA, MARVIN PALACIO (PT)
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:PALACIO
Last Name:CANITA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:PHIPPSBURG
Mailing Address - State:ME
Mailing Address - Zip Code:04562-4900
Mailing Address - Country:US
Mailing Address - Phone:646-752-3960
Mailing Address - Fax:
Practice Address - Street 1:1027 MAIN RD
Practice Address - Street 2:
Practice Address - City:PHIPPSBURG
Practice Address - State:ME
Practice Address - Zip Code:04562-4900
Practice Address - Country:US
Practice Address - Phone:646-752-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY024074225100000X
ME6109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty