Individual
DR. ELIZABETH JEAN CANONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
388 PLEASANT ST, SUITE 203, MALDEN, MA 02148-8143
(781) 388-0012
(781) 388-3312
Mailing address
88 CONVERSE LN, MELROSE, MA 02176-5121
(781) 632-5202
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
11243
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
468857
TUFTS PROVIDER NUMBER
MA
01
—
AA38236
HARVARD PILGRIM NUMBER
MA
01
—
Y67615
BCBS PROVIDER NUMBER
MA
Enumeration date
10/27/2005
Last updated
07/08/2007
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