Provider Demographics
NPI:1568747590
Name:MCCANN, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 COURT ST
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1408
Mailing Address - Country:US
Mailing Address - Phone:800-330-7711
Mailing Address - Fax:866-426-2811
Practice Address - Street 1:2852 N NAVAJO DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-4966
Practice Address - Country:US
Practice Address - Phone:928-772-9797
Practice Address - Fax:928-772-9340
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225100000X
AZ9569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist