Healthcare Provider Details

I. General information

NPI: 1205630522
Provider Name (Legal Business Name): HANNAH CANNON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 C M FAGAN DR STE H
HAMMOND LA
70403-5973
US

IV. Provider business mailing address

42424 FOREST LN
HAMMOND LA
70403-2181
US

V. Phone/Fax

Practice location:
  • Phone: 985-543-3850
  • Fax:
Mailing address:
  • Phone: 985-974-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12061
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: