Individual ProviderKanon BroussardPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address16405 Northcross Dr, Suite G-2, Huntersville, NC 28078-5091(866) 214-9644PECOS EnrollmentBased on the most recent information from CMS, provider Kanon Broussard does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:51 AM.Profile DetailsProvider ID1639521172Provider TypeIndividualFull NameBroussard, KanonGenderMaleSole ProprietorNoEnumeration Date7/8/2016Last Updated7/8/2016Contact InformationPractice LocationPractice Address16405 Northcross Dr, Suite G-2, Huntersville, NC 28078-5091Phone(866) 214-9644FaxUnlisted FaxMailing LocationMailing Address16405 Northcross Dr, Suite G-2, Huntersville, NC 28078-5091Phone(866) 214-9644FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense09393Louisiana