Provider Demographics
NPI:1063187284
Name:GHANAYEM, ROD (DPT)
Entity type:Individual
Prefix:
First Name:ROD
Middle Name:
Last Name:GHANAYEM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 VAN BUREN ST APT 705
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-5194
Mailing Address - Country:US
Mailing Address - Phone:207-992-3311
Mailing Address - Fax:
Practice Address - Street 1:309 71ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3013
Practice Address - Country:US
Practice Address - Phone:305-867-3925
Practice Address - Fax:305-867-3927
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist