Provider Demographics
NPI:1578772901
Name:GANZ, KIMBERLY A (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:GANZ
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 1:2797 NE 207TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1471
Mailing Address - Country:US
Mailing Address - Phone:305-528-1795
Mailing Address - Fax:786-453-0010
Practice Address - Street 1:2797 NE 207TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1471
Practice Address - Country:US
Practice Address - Phone:305-528-1795
Practice Address - Fax:786-453-0010
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist