Provider Demographics
NPI:1740322445
Name:KANNO, KEISUKE (DPT CSCS)
Entity type:Individual
Prefix:
First Name:KEISUKE
Middle Name:
Last Name:KANNO
Suffix:
Gender:M
Credentials:DPT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:480-551-4948
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:5750 S 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040
Practice Address - Country:US
Practice Address - Phone:602-437-5055
Practice Address - Fax:602-437-5395
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist