Provider Demographics
NPI:1689401390
Name:CANTER, MADALYN GRACE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:GRACE
Last Name:CANTER
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 1:6369 WAVERLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8008
Mailing Address - Country:US
Mailing Address - Phone:513-400-6069
Mailing Address - Fax:
Practice Address - Street 1:7080 GRANTHAM WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2129
Practice Address - Country:US
Practice Address - Phone:513-231-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist