Provider Demographics
NPI:1316427719
Name:CANNON, CHRISTINE (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 GLENHURST CT
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1759
Mailing Address - Country:US
Mailing Address - Phone:614-946-6883
Mailing Address - Fax:
Practice Address - Street 1:765 N HAMILTON RD STE 110
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8703
Practice Address - Country:US
Practice Address - Phone:614-566-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT7763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist