Theodore William Gannon, L. AC.

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

007468 Issued in OH

Practice address

4725 N Federal Hwy
Fort Lauderdale, FL 33308-4603

Phone

(954) 229-7908

NPI assigned

May 3, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1164634192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1648 CURRY DR",
            "city": "LYNDHURST",
            "state": "OH",
            "postal_code": "441242762",
            "telephone_number": "330-591-0287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4725 N FEDERAL HWY",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333084603",
            "telephone_number": "954-229-7908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "THEODORE",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "L. AC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "FL",
            "license": "1863",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OH",
            "license": "007468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juma Gangadeen, FNP-C
• Jamie L Ganger, LCSW
• Tricia A Gangoo, PHARMD
• Kristi Gannon
• Marc Jay Gannon, O.D.
• Anasuya Gaonkar, MD
• Roya Garakani
• Kelly Ann Garasz, RN
• Marjelin R Garay
• Harold Edward Garber, M.D.

• Physical Therapy Assistant in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.