Provider Demographics
NPI:1235236050
Name:KANG, FLORENA SHARON MAMBAJE (PT)
Entity Type:Individual
Prefix:
First Name:FLORENA
Middle Name:SHARON MAMBAJE
Last Name:KANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:FLORENA
Other - Middle Name:M
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:7502 ELDORADO PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1467
Mailing Address - Country:US
Mailing Address - Phone:469-424-3212
Mailing Address - Fax:469-793-8950
Practice Address - Street 1:7502 ELDORADO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1467
Practice Address - Country:US
Practice Address - Phone:469-424-3212
Practice Address - Fax:469-793-8950
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114565225100000X
TX1323320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist