MEDICARE: DR. BRIAN BASSIL KANONA DPT

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
1	225100000X	Physical Therapist	5501018759	MI

General Provider Information

NPI Number	:	1275014680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN BASSIL KANONA DPT

Provider Business Mailing Address
First Line	:	3780 MILANO CT
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2245
Country	:	US
Telephone Number	:	248-787-4717
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 MILANO CT
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2245
Country	:	US
Telephone Number	:	248-787-4717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	05/16/2024

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