Provider Demographics
NPI:1922083914
Name:CANNADAY, LAURA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:J
Last Name:CANNADAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-695-5144
Mailing Address - Fax:951-695-9345
Practice Address - Street 1:31720 TEMECULA PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5895
Practice Address - Country:US
Practice Address - Phone:951-696-9353
Practice Address - Fax:951-973-7216
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623066OtherBCBS PROVIDER #
IL367885100OtherUS DEPT OF LABOR
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL1623066OtherBCBS PROVIDER #
IL367885100OtherUS DEPT OF LABOR