Tabitha Lyn Ganske, PTA
Physical Medicine & Rehabilitation in Glen Carbon, IL. Individual provider (NPI-1).
NPI number1164023982
StatusActive
Last updated in NPPESNov 6, 2020
Details
- NPI
- 1164023982
- Entity type
- Individual (NPI-1)
- Name
- Tabitha Lyn Ganske
- Credential
- PTA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 6, 2020
- Certification date
- Nov 6, 2020
- Last updated
- Nov 6, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | 160.008904 | IL | Yes |
| 208100000X | Physical Medicine & Rehabilitation | 2019027272 | MO |
Practice location
27 Auerbach PlGlen Carbon, IL 62034-1596
Phone 618-288-3700
Mailing address
106 Echo Valley DrCollinsville, IL 62234-1498
Phone 618-401-3307
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