Provider Demographics
NPI:1801086301
Name:CANADAY, CHERYL ANN (PT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:CANADAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:NELLENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6405 JACK WRIGHT ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1910
Mailing Address - Country:US
Mailing Address - Phone:904-202-3420
Mailing Address - Fax:904-202-3332
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8202
Practice Address - Country:US
Practice Address - Phone:904-202-3420
Practice Address - Fax:904-202-3332
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist