Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kanon Broussard

Individual provider Physical Therapist · NPI 1639521172

Kanon Broussard is a Physical Therapist in Private Practice in Huntersville, North Carolina. Qualified in 2016, 10 years ago. Practices with Synergy Care Southeast LLC, a 199-clinician group and accepts Medicare assignment. Licensed in Louisiana.

Years since qualifying
10
Licensed in
LA
In the registry since
2016
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Practice location Address checks out

16405 Northcross Dr Ste G-2
Huntersville, NC 28078-5091
Phone: (866) 214-9644
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 09393 (LA)

Record details

NPI number1639521172
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 8, 2016
Last updated in NPPESJuly 8, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Synergy Care Southeast Llc — 199 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Huntersville