Provider Demographics
NPI:1215659404
Name:CANADAY, JACQUELYN LOY (LPTA)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:LOY
Last Name:CANADAY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15466 FOXVALE WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6535
Mailing Address - Country:US
Mailing Address - Phone:804-921-9647
Mailing Address - Fax:
Practice Address - Street 1:6701 IRONBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1469
Practice Address - Country:US
Practice Address - Phone:804-318-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601276225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant