Theodore William Gannon, L. Ac.
Physical Therapy Assistant in Fort Lauderdale, FL. Individual provider (NPI-1).
NPI number1164634192
StatusActive
Last updated in NPPESJan 17, 2023
Details
- NPI
- 1164634192
- Entity type
- Individual (NPI-1)
- Name
- Mr. Theodore William Gannon
- Credential
- L. Ac.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 3, 2007
- Certification date
- Jan 17, 2023
- Last updated
- Jan 17, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | 007468 | OH | Yes |
| 171100000X | Acupuncturist | 1863 | FL |
Practice location
4725 N Federal HwyFort Lauderdale, FL 33308-4603
Phone 954-229-7908
Mailing address
1648 Curry DrLyndhurst, OH 44124-2762
Phone 330-591-0287
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All 26 Physical Therapy Assistant providers in Fort Lauderdale · All 7,485 providers in Fort Lauderdale
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