Doctor Name: | KENNETH PANGANIBAN |
NPI Number: | 1124418934 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | MA59111 |
Business Practice Address: | 700 3rd St #202 Neptune Beach, FL - 322665072 |
Business Phone Number: | 9042495020 |
Business Fax Number: | |
Mailing Address: | 1015 Atlantic Blvd, #214 ATLANTIC BEACH |
State: | FL |
Postal Code: | 322333313 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/01/2015 |
NPI Last Update Date: | 02/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA59111 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |