Basic Information
| Provider Information | |||||||||
| NPI: | 1093822157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANNON | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8389 S INDEPENDENCE CIR UNIT 306 | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801289256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202559659 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5920 S ESTES ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801238619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039322500 | ||||||||
| FaxNumber: | 3039322600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7939 | 01 | CO | LICENSE # | OTHER |