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 1:660 CASCADE WEST PKWY SE STE 25
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2142
Mailing Address - Country:US
Mailing Address - Phone:616-229-4500
Mailing Address - Fax:616-228-9828
Practice Address - Street 1:660 CASCADE WEST PKWY SE STE 25
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2142
Practice Address - Country:US
Practice Address - Phone:616-229-4500
Practice Address - Fax:616-228-9828
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-07-11
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