Individual
KELLY CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
83 BROKAW BLVD, PLAINFIELD, NJ 07063-1067
(856) 383-9831
Mailing address
15 MONTROSE LN, WILLINGBORO, NJ 08046-2803
(856) 383-9831
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18KT01217200
NJ
Other
Enumeration date
10/13/2020
Last updated
01/10/2025
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