Jeremy Cannon, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

3416 Issued in SC

Practice address

95 Sea Island Pkwy Ste 103
Beaufort, SC 29907-1499

Phone

(803) 942-6412

NPI assigned

Mar 3, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tidal Creek Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Beaufort, SC
  • NPI 1598358954
  NPD Authorized official
• Tidal Creek Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Beaufort, SC
  • NPI 1851129977
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654905600000",
    "number": "1093175010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 SEA ISLAND PKWY STE 103",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299071499",
            "telephone_number": "843-379-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 SEA ISLAND PKWY STE 103",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299071499",
            "telephone_number": "803-942-6412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1787 Allendale Fairfax Hwy",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "SC",
            "postal_code": "298279133",
            "country_code": "US",
            "telephone_number": "803-632-3773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "JEREMY",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-03",
        "last_updated": "2022-06-11",
        "certification_date": "2022-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "3416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Calba Enterprises, LLC
• Kristin Callaghan, PA-C
• Claudia Elise Callison, LPC, NCC
• Donnie M. Campbell
• Gregory Reed Campbell, DMD
• Rachel Capitena, RBT
• Daniel J Cardin, PHARMD, RPH
• Cardinal Hospice LLC
• Carey Holdings Inc.
• Mark J Carey, DC

• Physical Therapy Assistant in Beaufort, SC
• Providers in Beaufort, SC by specialty
• Physical Therapy Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.