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NPI Code Detail

MEDICARE: JENNIFER MICHELLE CANNON P.T,

MEDICARE: JENNIFER MICHELLE CANNON P.T,
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1195568TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00954309OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1854T74OTHERTXBCBS ORTHOTEXAS

General Provider Information

NPI Number : 1144549213
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MICHELLE CANNON P.T,
Provider Business Mailing Address
First Line : 1060 THORNRIDGE CIR
Second Line :
City : ARGYLE
State : TX
Zip : 76226-2525
Country : US
Telephone Number : 940-595-0411
Fax Number :
Provider Business Practice Location Address
First Line : 2535 W OAK ST
Second Line :
City : DENTON
State : TX
Zip : 76201-2331
Country : US
Telephone Number : 940-382-1577
Fax Number : 940-387-5471
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2010
Last Update Date : 09/23/2011

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Directions to “ JENNIFER MICHELLE CANNON P.T,” Practice Location

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