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General NPI Number Information
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NPI Number | 1801825898
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Entity Type | Individual
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Provider Name | LISBETH ANNE GANNINGER P.T.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 105 W AVENIDA PICO
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4981
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Country | US
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Telephone | 949-361-8207
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Fax |
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Provider Business Mailing Address
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Address Line | 27 AVENIDA BRIO
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6844
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Country | US
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Telephone | 949-310-3267
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Fax | 949-492-1493
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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 | 27365
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License Number State | CA
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