Provider Demographics
NPI:1255675575
Name:CANOVA, LYNNE MARIE
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:MARIE
Last Name:CANOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LYNNE
Other - Middle Name:MARIE
Other - Last Name:PROCACINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:120 CARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1231
Mailing Address - Country:US
Mailing Address - Phone:412-607-5995
Mailing Address - Fax:
Practice Address - Street 1:120 CARRINGTON CT
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-1231
Practice Address - Country:US
Practice Address - Phone:412-607-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1001034225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant