Provider Demographics
NPI:1326549304
Name:CANO, CARLY ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ANN
Last Name:CANO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SPARROWHAWK LN
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-1016
Mailing Address - Country:US
Mailing Address - Phone:818-456-6641
Mailing Address - Fax:
Practice Address - Street 1:13425 VENTURA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3997
Practice Address - Country:US
Practice Address - Phone:818-877-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist