Provider Demographics
NPI:1225136039
Name:CANARINA, CYNTHIA ANN (PT DPT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANN
Last Name:CANARINA
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:MALLONEE QUINBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100551
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0551
Mailing Address - Country:US
Mailing Address - Phone:843-777-2250
Mailing Address - Fax:843-777-2051
Practice Address - Street 1:555 EAST CHEVES STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-0551
Practice Address - Country:US
Practice Address - Phone:843-777-2250
Practice Address - Fax:843-777-2051
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149673225100000X, 2251P0200X
SC5435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1587OtherBCBS