Provider Demographics
NPI:1184101198
Name:KANE, ANNIE MARIE (PT)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:MARIE
Last Name:KANE
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 1:706 N MCQUEEN RD STE 109
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3538
Mailing Address - Country:US
Mailing Address - Phone:480-630-2800
Mailing Address - Fax:480-630-2801
Practice Address - Street 1:706 N MCQUEEN RD STE 109
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3538
Practice Address - Country:US
Practice Address - Phone:480-630-2800
Practice Address - Fax:480-630-2801
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDPT-30079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist