Active NPI
Brian Keith Canan II
- Physical Therapy Assistant
- Winter Park, FL
National Provider Identifier
1730734443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A5240
- Practice address
- 925 S Semoran Blvd
Winter Park, FL 32792-5313 - Phone
- (407) 961-6297
- NPI assigned
- Aug 8, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A5240 | MD | Primary |
Addresses
Primary practice location
925 S Semoran Blvd
Winter Park, FL 32792-5313
Mailing address
PO Box 115
Bloomery, WV 26817-0115
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A5240 | Medicaid | MD |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A5240 | MD | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565222400000",
"number": "1730734443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 115",
"city": "BLOOMERY",
"state": "WV",
"postal_code": "268170115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 S SEMORAN BLVD",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327925313",
"telephone_number": "407-961-6297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANAN",
"first_name": "BRIAN",
"middle_name": "KEITH",
"name_suffix": "II",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-08-08",
"last_updated": "2019-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MD",
"license": "A5240",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "A5240",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winter Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.