Provider Demographics
NPI:1386182863
Name:GANZ, KIM ATTON (PTA)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:ATTON
Last Name:GANZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ATTON
Other - Last Name:GANZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:3900 FREEDOM CIR
Mailing Address - Street 2:201
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1222
Mailing Address - Country:US
Mailing Address - Phone:408-334-4987
Mailing Address - Fax:
Practice Address - Street 1:3900 FREEDOM CIR
Practice Address - Street 2:201
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1222
Practice Address - Country:US
Practice Address - Phone:408-334-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA2235225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant