Provider Demographics
NPI:1376323865
Name:CANORI MATTHEWS, ALEXANDRA (PT, DPT, PHD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:CANORI MATTHEWS
Suffix:
Gender:F
Credentials:PT, DPT, PHD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:CANORI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT, PHD
Mailing Address - Street 1:10 AMSTERDAM AVE APT 705
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 AMSTERDAM AVE APT 705
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7490
Practice Address - Country:US
Practice Address - Phone:908-797-1363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040387225100000X
PAPT025580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist