Basic Information
| Provider Information | |||||||||
| NPI: | 1093940819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANION | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2805 | ||||||||
| Address2: | |||||||||
| City: | BANDERA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780032805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307963447 | ||||||||
| FaxNumber: | 8307963685 | ||||||||
| Practice Location | |||||||||
| Address1: | 3456 HWY 16 SOUTH | ||||||||
| Address2: | |||||||||
| City: | BANDERA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307963447 | ||||||||
| FaxNumber: | 8307963685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2009 | ||||||||
| LastUpdateDate: | 05/22/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 132266 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.