Individual provider Active NPI

Connie L Canant, PT

  • Physical Therapist
  • Tucson, AZ
National Provider Identifier
1124110101
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2665 Issued in AZ
Practice address
2600 N Wyatt Dr
Tucson, AZ 85712-6106
Phone
(520) 324-3600
Fax
(520) 324-3129
NPI assigned
Sep 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2665 AZ Primary

Addresses

Primary practice location

2600 N Wyatt Dr
Tucson, AZ 85712-6106

Mailing address

2600 N Wyatt Dr
Tucson, AZ 85712-6106
Phone (520) 324-3600

Other identifiers 1

IdentifierTypeStateIssuer
427262MedicaidAZ

Other names 1

  • Connie L Dilorenzo Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2665AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dynamite Therapy, LLC PastSince Sep 9, 2011 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1124110101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 N WYATT DR",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857126106",
            "telephone_number": "520-324-3600",
            "fax_number": "520-324-3129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 N WYATT DR",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857126106",
            "telephone_number": "520-324-3600",
            "fax_number": "520-324-3129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANANT",
        "first_name": "CONNIE",
        "middle_name": "L",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "2665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "427262",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONNIE",
            "last_name": "DILORENZO",
            "middle_name": "L",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.