MEDICARE: ROBIN C KANANEN

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	PT017349	OH

General Provider Information

NPI Number	:	1710471255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN C KANANEN

Provider Business Mailing Address
First Line	:	1448 BELL RD
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-4245
Country	:	US
Telephone Number	:	512-787-7423
Fax Number	:

Provider Business Practice Location Address
First Line	:	20370 LORAIN RD
Second Line	:
City	:	FAIRVIEW PARK
State	:	OH
Zip	:	44126-3411
Country	:	US
Telephone Number	:	440-356-3213
Fax Number	:	440-331-0453

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

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	06/19/2018

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