Basic Information
| Provider Information | |||||||||
| NPI: | 1609853043 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANNON | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | ELLIOTT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1517 CARTER ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232206903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049204277 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1465 JOHNSTON WILLIS DR | ||||||||
| Address2: | |||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232354730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043203668 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 09/23/2016 | ||||||||
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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 | 2305204298 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.