MEDICARE: MRS. JANET MK GANGAWAY PT, OCS, ATC

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
1	2251X0800X	Orthopedic Physical Therapist	5103	CT

General Provider Information

NPI Number	:	1689741746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET MK GANGAWAY PT, OCS, ATC

Provider Business Mailing Address
First Line	:	147 BRENTMOOR RD
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-1709
Country	:	US
Telephone Number	:	860-568-7783
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 BLOOMFIELD AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-1545
Country	:	US
Telephone Number	:	860-768-5335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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