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NPI Code Detail

MEDICARE: MRS. ELLEN ANN GALLAGHER

MEDICARE: MRS. ELLEN ANN GALLAGHER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantTE001435LPA

General Provider Information

NPI Number : 1609992338
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELLEN ANN GALLAGHER
Provider Business Mailing Address
First Line : 3337 DECATUR ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19136-3021
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1104 WELSH RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-3730
Country : US
Telephone Number : 215-676-9191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 07/08/2007

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