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General NPI Number Information
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NPI Number | 1689103558
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Entity Type | Individual
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Provider Name | MICHELLE R GANIBAN PT
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Gender | Female
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 1201 ALHAMBRA BLVD STE 210
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City | SACRAMENTO
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State | CA
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Zip | 95816-5241
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Country | US
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Telephone | 916-731-7900
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Fax | 916-731-7315
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Provider Business Mailing Address
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Address Line | 2750 GATEWAY OAKS DR STE 310
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City | SACRAMENTO
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State | CA
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Zip | 95833-3658
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Country | US
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Telephone | 916-887-7398
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Fax | 916-503-3886
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT39307
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License Number State | CA
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