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Individual

MR. SURESH GANU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMT,COMT

Contact information

Practice address
400 COLLINS ROAD NE, ROCKWELL REC. CENTER, CEDAR RAPIDS, IA 52404
(319) 721-0949
Mailing address
PO BOX 218, ELY, IA 52227-0218
(319) 721-0949

Taxonomy

Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
04048
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
04048
MECHANOTHERAPIST -MASSAGE THERAPIST
IA
Enumeration date
09/18/2008
Last updated
09/18/2008
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