Provider Demographics
NPI:1861204612
Name:CANTZ, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 FERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-4949
Mailing Address - Country:US
Mailing Address - Phone:518-858-5492
Mailing Address - Fax:518-246-4781
Practice Address - Street 1:100 SARATOGA VILLAGE BLVD STE 9
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-3703
Practice Address - Country:US
Practice Address - Phone:518-886-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY786887163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse