Provider Demographics
NPI:1659519270
Name:GANLEY, KATHLEEN JODELL (PT, PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JODELL
Last Name:GANLEY
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PINE KNOLL DR BLDG 66 RM 103
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86011-0001
Mailing Address - Country:US
Mailing Address - Phone:928-523-4092
Mailing Address - Fax:928-523-9289
Practice Address - Street 1:208 PINE KNOLL DR BLDG 66 RM 103
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86011-0001
Practice Address - Country:US
Practice Address - Phone:928-523-4092
Practice Address - Fax:928-523-9289
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics