Provider Demographics
NPI:1881948925
Name:GANIH, KENAN (DPT)
Entity type:Individual
Prefix:MR
First Name:KENAN
Middle Name:
Last Name:GANIH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 SHOOTING STAR ST
Mailing Address - Street 2:
Mailing Address - City:PLUMAS LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95961-8707
Mailing Address - Country:US
Mailing Address - Phone:530-786-4521
Mailing Address - Fax:
Practice Address - Street 1:1429 COLUSA HWY STE A
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-9456
Practice Address - Country:US
Practice Address - Phone:530-786-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-27
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist