Healthcare Provider Details

I. General information

NPI: 1265705818
Provider Name (Legal Business Name): THOMAS DAVID CANNON M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E MILLTOWN RD
WOOSTER OH
44691-1255
US

IV. Provider business mailing address

1740 CLEVELAND RD
WOOSTER OH
44691-2204
US

V. Phone/Fax

Practice location:
  • Phone: 330-287-4580
  • Fax: 330-287-4581
Mailing address:
  • Phone: 330-287-4500
  • Fax: 330-287-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: