Individual
KEVIN CHARLES CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
100 EMANCIPATION DR, HAMPTON, VA 23667-2254
(757) 722-9961
Mailing address
200 SMITH DR, SMITHFIELD, VA 23430-1443
(801) 360-5826
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
11285279-2401
UT
2251C2600X
Cardiopulmonary Physical Therapist
Primary
1572324
WI
Other
Enumeration date
10/01/2020
Last updated
07/23/2025
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