Provider Demographics
NPI:1770824393
Name:CANNER, LAUREN R (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:R
Last Name:CANNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:R
Other - Last Name:PASQUARELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2049 BRIAN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1701
Mailing Address - Country:US
Mailing Address - Phone:631-786-4503
Mailing Address - Fax:
Practice Address - Street 1:225 EXECUTIVE DR
Practice Address - Street 2:SUITE LL108
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1718
Practice Address - Country:US
Practice Address - Phone:516-576-2040
Practice Address - Fax:516-576-2131
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031792-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist