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NPI Code Detail

MEDICARE: MR. TRAVIS STEVEN GALLAGHER ATC

MEDICARE: MR. TRAVIS STEVEN GALLAGHER ATC
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
12255A2300XAthletic TrainerAT 1344OH

General Provider Information

NPI Number : 1891910386
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TRAVIS STEVEN GALLAGHER ATC
Provider Business Mailing Address
First Line : 584 COUNTY LINE RD W
Second Line :
City : WESTERVILLE
State : OH
Zip : 43082-7295
Country : US
Telephone Number : 614-355-6019
Fax Number :
Provider Business Practice Location Address
First Line : 584 COUNTY LINE RD W
Second Line :
City : WESTERVILLE
State : OH
Zip : 43082-7295
Country : US
Telephone Number : 614-355-6019
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 02/01/2017

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