Provider Demographics
NPI:1487792461
Name:CANALES, WILFREDO
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:CANALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 NE MIAMI GARDENS DR APT 1525
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4994
Mailing Address - Country:US
Mailing Address - Phone:305-333-0879
Mailing Address - Fax:
Practice Address - Street 1:1301 NE MIAMI GARDENS DR APT 1525
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33179-4994
Practice Address - Country:US
Practice Address - Phone:305-333-0879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL287313OtherWELLCARE (ATA)
FL2903OtherTHC
FL699013OtherUHC
FL889671200Medicaid
FL276370OtherAMERIGROUP
FL4446OtherTRS (HUMANA)
FLY032DOtherBCBS