Individual
MR. LYLES BLALOCK CANNON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT, MS
Contact information
Practice address
8131 RITCHIE HWY, SUITE E, PASADENA, MD 21122-6940
(410) 590-4360
(410) 590-4365
Mailing address
6464 CEDAR FURNACE CIR, GLEN BURNIE, MD 21061-8825
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
21457
MD
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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