Marcie L. Ganson, PT, DPT, MBA
Individual provider Active NPI Physical Therapist · Havana, IL
NPI 1992068027 · NPPES record last updated Jun 27, 2012
Key facts
- NPI
- 1992068027
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070.011155 (IL)
- Practice address
- 615 N Promenade St
Havana, IL 62644-1243 - Phone
- (309) 543-8578
- Fax
- (309) 543-8571
- NPI assigned
- Jun 22, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.011155 | IL | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.011155 | IL | Yes |
Addresses
Primary practice location
615 N Promenade St
Havana, IL 62644-1243
Mailing address
615 N Promenade St
PO Box 530
Havana, IL 62644-1243
Phone (309) 543-8578
Other providers in Havana, IL
- Dr. Strauman
- Kaitlyn Lee Fields
- Faythe Reyhan Flinn
- Foot and Ankle Associates of Central Illinois LLC
- Yvonne Lynn Fornoff
- Randall Joe Goodman II
- Becky Jane Hart
- Havana Cusd 126
- Havana Hco, LLC
- Havana Hco, LLC
All providers in Havana, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.