Provider Demographics
NPI:1336520485
Name:CANTWELL, BIANCA (PT,DPT)
Entity type:Individual
Prefix:MISS
First Name:BIANCA
Middle Name:
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06331-0483
Mailing Address - Country:US
Mailing Address - Phone:860-556-9395
Mailing Address - Fax:860-556-9396
Practice Address - Street 1:180 WESTMINSTER RD
Practice Address - Street 2:
Practice Address - City:CANTERBURY
Practice Address - State:CT
Practice Address - Zip Code:06331-1431
Practice Address - Country:US
Practice Address - Phone:860-556-9395
Practice Address - Fax:860-556-9396
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3985225100000X
CT009736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist