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NPI Code Detail

MEDICARE: JEFF GALLICHAN PTA

MEDICARE: JEFF GALLICHAN PTA
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 AssistantPTA8658FL

General Provider Information

NPI Number : 1841846300
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFF GALLICHAN PTA
Provider Business Mailing Address
First Line : 260 1ST AVE S STE 200
Second Line :
City : SAINT PETERSBURG
State : FL
Zip : 33701-4364
Country : US
Telephone Number : 727-803-1102
Fax Number :
Provider Business Practice Location Address
First Line : 255 E MAIN ST
Second Line :
City : LAKE ALFRED
State : FL
Zip : 33850-2133
Country : US
Telephone Number : 727-803-1102
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2019
Last Update Date : 08/12/2019

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