Individual
DERRICK CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
79 W ALEXANDRINE ST, DETROIT, MI 48201-2015
(313) 831-5535
Mailing address
41834 SAVAGE RD, VAN BUREN TWP, MI 48111-3095
(419) 310-3190
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501019771
MI
225100000X
Physical Therapist
PHYP2677
AK
Other
Enumeration date
10/11/2013
Last updated
02/19/2025
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