Provider Demographics
NPI:1245037233
Name:CANFIELD, CALEB TIMOTHY (DPT)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:TIMOTHY
Last Name:CANFIELD
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 E DELLWOOD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6446
Mailing Address - Country:US
Mailing Address - Phone:806-642-8398
Mailing Address - Fax:
Practice Address - Street 1:3765 E BLUE LUPINE DR STE D
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8417
Practice Address - Country:US
Practice Address - Phone:907-707-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK232938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist