Provider Demographics
NPI:1912164138
Name:CANNY, BETH QUINN
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:QUINN
Last Name:CANNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3482
Mailing Address - Country:US
Mailing Address - Phone:860-482-9019
Mailing Address - Fax:
Practice Address - Street 1:607 BANTAM RD
Practice Address - Street 2:UNIT H
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-1634
Practice Address - Country:US
Practice Address - Phone:860-567-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001008225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant