Kellen Cannon

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

9 Lee Airpark Dr Ste 400
Edgewater, MD 21037-1229

Phone

(443) 607-1469

NPI assigned

Sep 19, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD, TX, MA3 enrollments

Enrollment records 3

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ati Holdings, LLCGroup PAC ID 9537112719, 440 clinicians

Performance Rehabilitation of Western New England LLCGroup PAC ID 7911979950, 201 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

85.56 of 100Reported as group

Quality

89.48

Improvement activities

40

Cost

71.16

Merit-based Incentive Payment System (MIPS)

Final score

88.48 of 100Reported as group

Quality

86.04

Promoting interoperability

99

Improvement activities

40

Cost

76.38

Merit-based Incentive Payment System (MIPS)

Final score

86.05 of 100Reported as group

Quality

89.12

Improvement activities

40

Cost

73.46

Medicare enrollment (NPD)

Enrolled

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.

• Ati Holdings, LLC

  • Physical Therapy Clinic/Center
  • Rising Sun, MD
  • NPI 1396781050
  Medicare reassignment Care Compare group
• Performance Rehabilitation of Western New England LLC

  • Physical Therapist
  • West Springfield, MA
  • NPI 1710919063
  Medicare reassignment Care Compare group
• Ideal Physical Therapy of Texas LLC

  • Physical Therapist
  • Plano, TX
  • NPI 1538573746
  Medicare reassignment NPD
• Ideal Physical Therapy of Texas LLC

  • Durable Medical Equipment & Medical Supplies
  • Murphy, TX
  • NPI 1902773161
  NPD
• Professional Sportscare & Rehab, LLC

  • Physical Therapist
  • Woodbridge, VA
  • NPI 1548714959
  NPD (past)

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

{
    "created_epoch": "1632009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1447920699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 BUTTERFIELD RD STE 1600",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151211",
            "telephone_number": "866-370-8206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 LEE AIRPARK DR STE 400",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210371229",
            "telephone_number": "443-607-1469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "212 Rosewick Rd",
            "address_purpose": "LOCATION",
            "city": "LA Plata",
            "state": "MD",
            "postal_code": "206464216",
            "country_code": "US",
            "telephone_number": "240-776-6900",
            "fax_number": "240-261-5321",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1715 N George Mason Dr",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "VA",
            "postal_code": "222053609",
            "country_code": "US",
            "telephone_number": "703-525-5542 x200",
            "fax_number": "703-525-2739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "KELLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-19",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": "2305214662",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordyn Milan Brown
• Jason Allen Bunting, PHARM.D.
• Rachel Susan Burda, NP
• Allison Calabrese
• Judith Ann Cannon, RN
• Timothy Caprio, DPT, PT
• Allan D Carpio, OTR/L
• Veronica Castillo, LGPC
• Florence Marea Catoe, CRNP FNP-BC
• Changing Tides Therapy Center, LLC

• Physical Therapist in Edgewater, MD
• Providers in Edgewater, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.