Provider Demographics
NPI:1841362308
Name:ALCANTAR, JANENE KATHRYN (PT)
Entity type:Individual
Prefix:MRS
First Name:JANENE
Middle Name:KATHRYN
Last Name:ALCANTAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20702 N LAKE PLEASANT RD
Mailing Address - Street 2:APT 1152
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-0536
Mailing Address - Country:US
Mailing Address - Phone:623-261-1332
Mailing Address - Fax:
Practice Address - Street 1:16140 N ARROWHEAD FOUNTAIN CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-572-6776
Practice Address - Fax:623-572-6962
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ73092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036551Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER