MEDICARE: BRIAN KEITH CANAN II

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	225200000X	Physical Therapy Assistant	A5240	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730734443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN KEITH CANAN II

Provider Business Mailing Address
First Line	:	PO BOX 115
Second Line	:
City	:	BLOOMERY
State	:	WV
Zip	:	26817-0115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 S SEMORAN BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-5313
Country	:	US
Telephone Number	:	407-961-6297
Fax Number	:

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

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	08/08/2019

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Directions to “ BRIAN KEITH CANAN II ” Practice Location

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