Provider Demographics
NPI:1144481813
Name:CANZANELLI, LINDA CAROL (PTA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:CANZANELLI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1104
Mailing Address - Country:US
Mailing Address - Phone:781-862-6797
Mailing Address - Fax:
Practice Address - Street 1:21 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1104
Practice Address - Country:US
Practice Address - Phone:781-862-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3919225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant