Provider Demographics
NPI:1578877759
Name:GANESH, MICHELE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:GANESH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 NW 69TH CT
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5353
Mailing Address - Country:US
Mailing Address - Phone:954-721-6261
Mailing Address - Fax:954-721-6261
Practice Address - Street 1:6846 NW 69TH CT
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5353
Practice Address - Country:US
Practice Address - Phone:954-721-6261
Practice Address - Fax:954-721-6261
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA23547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist