Healthcare Provider Details

I. General information

NPI: 1275670374
Provider Name (Legal Business Name): KAREN CANN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4657 GULF BREEZE PKWY. SUITES A & B
GULF BREEZE FL
32563
US

IV. Provider business mailing address

4657 GULF BREEZE PKWY. SUITE A
GULF BREEZE FL
32563
US

V. Phone/Fax

Practice location:
  • Phone: 850-916-9304
  • Fax: 850-916-9306
Mailing address:
  • Phone: 850-916-9304
  • Fax: 850-916-9306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8649
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20841
License Number StateFL

VIII. Authorized Official

Name: DR. KAREN A CANN
Title or Position: OWNER
Credential: D.C., L.P.T.
Phone: 850-916-9304