Clinton Kincannon

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA29228 Issued in FL

Practice address

12120 County Road 103
Oxford, FL 34484-2987

Phone

(352) 571-5554

NPI assigned

Feb 22, 2025

Last updated

Feb 22, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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)

Enrolled

State licenses

Practice roles

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

• Trinity Therapy FL, LLC

  • Physical Therapy Clinic/Center
  • Oxford, FL
  • NPI 1265263669
  NPD

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

{
    "created_epoch": "1740182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740182400000",
    "number": "1134925829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 61",
            "city": "OXFORD",
            "state": "FL",
            "postal_code": "344840061",
            "telephone_number": "352-571-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12120 COUNTY ROAD 103",
            "city": "OXFORD",
            "state": "FL",
            "postal_code": "344842987",
            "telephone_number": "352-571-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINCANNON",
        "first_name": "CLINTON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-22",
        "last_updated": "2025-02-22",
        "certification_date": "2025-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA29228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ieshia L Jones, SURGICAL ASSISTANT
• Kim Jones
• Saumilkumar S. Karavadia, MD
• Sharon Kimberley Kelton Durrance
• Katherine Elizabeth Kennedy, DPT
• La Plus Family Investment 2
• Kristen Ashley Leblanc, MS, OTR/L
• Rania Livada, DDS, MS
• Amanda Sharron Lober
• Lowell F Clark MD PA

• Physical Therapy Assistant in Oxford, FL
• Providers in Oxford, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2025; 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.