Provider Demographics
NPI:1023027752
Name:GANN, NANCY MARION (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARION
Last Name:GANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MADISON OAK DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 MADISON OAK DR
Practice Address - Street 2:SUITE 360
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3943
Practice Address - Country:US
Practice Address - Phone:210-545-4006
Practice Address - Fax:210-545-4096
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1903OtherBLUE CROSS BLUE SHIELD
TX0039871OtherBLUE LINK NO.
TX8B2109Medicare ID - Type Unspecified