=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578772901
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY A GANZ P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 09/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2797 NE 207TH ST SUITE 101
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-528-1795
-----------------------------------------------------
Fax | 786-453-0010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2797 NE 207TH ST SUITE 101
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-528-1795
-----------------------------------------------------
Fax | 786-453-0010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 21985
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------