Individual
MRS. JESSICA R GANGAWARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
1700 S LINCOLN AVE, LEBANON, PA 17042-7529
(717) 272-6621
Mailing address
650 E INDIAN SCHOOL ROAD, PHOENIX, AZ 85012-0777
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
68009
PA
Other
Enumeration date
02/10/2017
Last updated
08/12/2020
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