Active NPI
Lyles Blalock Cannon III, MPT, MS
- Physical Therapist
- Pasadena, MD
National Provider Identifier
1952409625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 21457
- Practice address
- 8131 Ritchie Hwy
Suite E
Pasadena, MD 21122-6940 - Phone
- (410) 590-4360
- Fax
- (410) 590-4365
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 21457 | MD | Primary |
Addresses
Primary practice location
8131 Ritchie Hwy
Suite E
Pasadena, MD 21122-6940
Mailing address
6464 Cedar Furnace Cir
Glen Burnie, MD 21061-8825
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21457 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1952409625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6464 CEDAR FURNACE CIR",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210618825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8131 RITCHIE HWY",
"address_2": "SUITE E",
"city": "PASADENA",
"state": "MD",
"postal_code": "211226940",
"telephone_number": "410-590-4360",
"fax_number": "410-590-4365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "LYLES",
"middle_name": "BLALOCK",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "MPT, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "21457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.