Provider Demographics
NPI:1558736330
Name:CANETTI, REBECCA (ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CANETTI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 COTTAGE ST
Mailing Address - Street 2:APT 6D
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-5141
Mailing Address - Country:US
Mailing Address - Phone:717-304-2826
Mailing Address - Fax:
Practice Address - Street 1:65 COTTAGE ST
Practice Address - Street 2:APT 6D
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-5141
Practice Address - Country:US
Practice Address - Phone:717-304-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20000100772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer