| Cannon Therapy | |
|
2909 Bent Ave Cheyenne WY 82001-2742 | |
| (970) 290-9897 | |
| Not Available |
| Full Name | Cannon Therapy |
|---|---|
| Speciality | Clinic/Center |
| Location | 2909 Bent Ave, Cheyenne, Wyoming |
| Authorized Official Name and Position | Gregory V Stelzner (OWNER) |
| Authorized Official Contact | 9702909897 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cannon Therapy Po Box 20885 Cheyenne WY 82003-7018 | Cannon Therapy 2909 Bent Ave Cheyenne WY 82001-2742 Ph: (970) 290-9897 |
| NPI Number | 1841947926 |
|---|---|
| Provider Enumeration Date | 03/08/2022 |
| Last Update Date | 03/08/2022 |
| Certification Date | 03/08/2022 |
| Medicare PECOS PAC ID | 9638558869 |
|---|---|
| Medicare Enrollment ID | O20220620000035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841947926 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| Provider Name | Gregory V Stelzner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003179649 PECOS PAC ID: 5092022608 Enrollment ID: I20150915001365 |
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