Provider Demographics
NPI:1891568887
Name:GANUS, TERRY R (DOM)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:R
Last Name:GANUS
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:R
Other - Last Name:GANUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:3205 SOUTHGATE CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5514
Mailing Address - Country:US
Mailing Address - Phone:941-306-7119
Mailing Address - Fax:
Practice Address - Street 1:3205 SOUTHGATE CIR STE 3
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5514
Practice Address - Country:US
Practice Address - Phone:941-306-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4530171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist