Provider Demographics
NPI:1750415386
Name:CANTERINO, TRACEE M (MSPT)
Entity type:Individual
Prefix:MRS
First Name:TRACEE
Middle Name:M
Last Name:CANTERINO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1737
Mailing Address - Country:US
Mailing Address - Phone:215-692-3891
Mailing Address - Fax:
Practice Address - Street 1:3 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1737
Practice Address - Country:US
Practice Address - Phone:215-692-3891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10940225100000X
PAPT017428225100000X
MO20210006571225100000X
UT12991489-2401225100000X
NY023012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist