Provider Demographics
NPI:1598504045
Name:CANFIELD, RAE ELLEN (DPT, PT)
Entity type:Individual
Prefix:MRS
First Name:RAE
Middle Name:ELLEN
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HIDDEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9190
Mailing Address - Country:US
Mailing Address - Phone:262-716-5579
Mailing Address - Fax:
Practice Address - Street 1:133 HIDDEN CREEK RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-9190
Practice Address - Country:US
Practice Address - Phone:262-716-5579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist