Provider Demographics
NPI:1649930504
Name:AMIE GAHAN PHYSICAL THERAPY AND WELLNESS INC
Entity type:Organization
Organization Name:AMIE GAHAN PHYSICAL THERAPY AND WELLNESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/PT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:ROVANE
Authorized Official - Last Name:GAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-938-2038
Mailing Address - Street 1:680 LIGHTHOUSE AVE UNIT 51695
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-8083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:542 LIGHTHOUSE AVE UNIT 106
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2777
Practice Address - Country:US
Practice Address - Phone:310-938-2038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty