Basic Information
| Provider Information | |||||||||
| NPI: | 1154667178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANSS | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, AT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5812 APPLEWOOD | ||||||||
| Address2: | 702 | ||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483223474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2315109932 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4660 S HAGADORN RD | ||||||||
| Address2: | 420 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178846100 | ||||||||
| FaxNumber: | 5178846233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2012 | ||||||||
| LastUpdateDate: | 12/19/2012 | ||||||||
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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 | 2255A2300X | 2601000362 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.