Provider Demographics
NPI:1700832805
Name:CANOS-TORRES, ALICIA (PT, MOMT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:CANOS-TORRES
Suffix:
Gender:F
Credentials:PT, MOMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 N BRETON CT SE STE 101
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8438
Mailing Address - Country:US
Mailing Address - Phone:616-229-4500
Mailing Address - Fax:616-229-4500
Practice Address - Street 1:4660 N BRETON CT SE STE 101
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-8438
Practice Address - Country:US
Practice Address - Phone:616-229-4500
Practice Address - Fax:616-229-4500
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650D115860OtherBCBSM
MI650D115860OtherBCBSM