Provider Demographics
NPI:1518337229
Name:GANZ, SUSAN E (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:GANZ
Suffix:
Gender:F
Credentials:PHD, ATC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 LOMALAND DRIVE
Mailing Address - Street 2:POINT LOMA NAZARENE UNIVERSITY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106
Mailing Address - Country:US
Mailing Address - Phone:619-849-2704
Mailing Address - Fax:619-849-3215
Practice Address - Street 1:3900 LOMALAND DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2810
Practice Address - Country:US
Practice Address - Phone:619-849-2704
Practice Address - Fax:619-849-3215
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer