Provider Demographics
NPI:1376753194
Name:ALCANTARA, JANISE CO (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANISE
Middle Name:CO
Last Name:ALCANTARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5913 PEPPERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1142
Mailing Address - Country:US
Mailing Address - Phone:562-804-1860
Mailing Address - Fax:
Practice Address - Street 1:1913 E 5TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2024
Practice Address - Country:US
Practice Address - Phone:562-432-5751
Practice Address - Fax:562-435-6394
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist