Active NPI
Kelly Cannon
- Massage Therapist
- Plainfield, NJ
National Provider Identifier
1801494844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 18KT01217200
- Practice address
- 83 Brokaw Blvd
Plainfield, NJ 07063-1067 - Phone
- (856) 383-9831
- NPI assigned
- Oct 13, 2020
- Last updated
- Jan 10, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 18KT01217200 | NJ | Primary |
Addresses
Primary practice location
83 Brokaw Blvd
Plainfield, NJ 07063-1067
Mailing address
15 Montrose LN
Willingboro, NJ 08046-2803
Phone (856) 383-9831
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18KT01217200 | NJ | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736467200000",
"number": "1801494844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 MONTROSE LN",
"city": "WILLINGBORO",
"state": "NJ",
"postal_code": "080462803",
"telephone_number": "856-383-9831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "83 BROKAW BLVD",
"city": "PLAINFIELD",
"state": "NJ",
"postal_code": "070631067",
"telephone_number": "856-383-9831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-13",
"last_updated": "2025-01-10",
"certification_date": "2025-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NJ",
"license": "18KT01217200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plainfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.