MEDICARE: VERONICA GANNON PT, DPT

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	225100000X	Physical Therapist	PT295984	CA

General Provider Information

NPI Number	:	1417500703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA GANNON PT, DPT

Provider Business Mailing Address
First Line	:	10362 FLORALITA AVE
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91040-1816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3810 LA CRESCENTA AVE
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3914
Country	:	US
Telephone Number	:	818-369-7700
Fax Number	:

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

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	02/11/2022

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