Provider Demographics
NPI:1932882164
Name:CANELON, JOSE (DPT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CANELON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5313 GOLF DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-3307
Mailing Address - Country:US
Mailing Address - Phone:229-269-0158
Mailing Address - Fax:
Practice Address - Street 1:3527 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6418
Practice Address - Country:US
Practice Address - Phone:229-247-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist