Basic Information
| Provider Information | |||||||||
| NPI: | 1043623622 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PANGANDAMAN | ||||||||
| FirstName: | ANNISAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1580 SAWGRASS CORPORATE PKWY,MEDPRO HEALTHCARRE STAFFIN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543324445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1580 SAWGRASS CORPORATE PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543324445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2014 | ||||||||
| LastUpdateDate: | 06/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 036530 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 070.020398 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 4455 | NM | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.