Individual
CLINTON KINCANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12120 COUNTY ROAD 103, OXFORD, FL 34484-2987
(352) 571-5554
Mailing address
PO BOX 61, OXFORD, FL 34484-0061
(352) 571-5554
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA29228
FL
Other
Enumeration date
02/22/2025
Last updated
02/22/2025
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