Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003230772 |
---|---|
Provider Name | Sandra Ganen |
First Address | Miami Lakes, FL 33014-2429 |
Second Address | Miami Lakes, FL 33014-2429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2014 |
Last Update Date | 14/02/2014 |