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General NPI Number Information
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NPI Number | 1538766720
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Entity Type | Individual
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Provider Name | KEVIN CHARLES CANNON DPT
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Gender | Male
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 100 EMANCIPATION DR
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City | HAMPTON
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State | VA
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Zip | 23667-2254
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Country | US
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Telephone | 757-722-9961
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Fax |
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Provider Business Mailing Address
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Address Line | 200 SMITH DR
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City | SMITHFIELD
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State | VA
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Zip | 23430-1443
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Country | US
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Telephone | 801-360-5826
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11285279-2401
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2251C2600X
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Taxonomy Name | Cardiopulmonary Physical Therapist
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License Number | 1572324
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License Number State | WI
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