Individual
KENNETH PANGANIBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
232 PONTE VEDRA PARK DR, PONTE VEDRA BEACH, FL 32082-6600
(904) 634-0640
(904) 634-0203
Mailing address
10270 STALLION RUN COURT, JACKSONVILLE, FL 32257
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA25367
FL
225700000X
Massage Therapist
MA59111
FL
Other
Enumeration date
02/01/2015
Last updated
08/11/2017
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