Provider Demographics
NPI:1083056618
Name:CANNALUNGA, LIDIA (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:LIDIA
Middle Name:
Last Name:CANNALUNGA
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 1:154 RIVERRUN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-1934
Mailing Address - Country:US
Mailing Address - Phone:864-590-1810
Mailing Address - Fax:
Practice Address - Street 1:355 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4628
Practice Address - Country:US
Practice Address - Phone:864-577-7587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2638225100000X
SC576000919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist