Provider Demographics
NPI:1861686149
Name:CANAL, WENCESTER DEAN ROSIANA (PT)
Entity Type:Individual
Prefix:MR
First Name:WENCESTER
Middle Name:DEAN ROSIANA
Last Name:CANAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 AITKIN LOOP
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-2963
Mailing Address - Country:US
Mailing Address - Phone:352-751-6627
Mailing Address - Fax:
Practice Address - Street 1:134 N OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-4347
Practice Address - Country:US
Practice Address - Phone:352-751-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist