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Individual
TRACEY MICHELLE CANNON
Active
Individual
TRACEY MICHELLE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
19215
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KBC4HO-61628901
BC/BS
MD
01
—
S404-0008
CAREFIRST
MD
Enumeration date
07/16/2006
Last updated
07/10/2008
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