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NPI Code Detail

MEDICARE: DIANA GANAHL PTA

MEDICARE: DIANA GANAHL PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant7715OR

General Provider Information

NPI Number : 1568811768
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA GANAHL PTA
Provider Business Mailing Address
First Line : 8823 PRODUCTION LN
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-6511
Country : US
Telephone Number : 423-238-7217
Fax Number :
Provider Business Practice Location Address
First Line : 4132 DEVONSHIRE CT NE
Second Line :
City : SALEM
State : OR
Zip : 97305-1982
Country : US
Telephone Number : 503-364-5313
Fax Number : 503-364-5296
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2016
Last Update Date : 06/08/2016

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Directions to “ DIANA GANAHL PTA” Practice Location

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