Healthcare Provider Details

I. General information

NPI: 1891086625
Provider Name (Legal Business Name): GAL PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 MOORPARK AVE. SUITE 20
SAN JOSE CA
95117-1597
US

IV. Provider business mailing address

4155 MOORPARK AVE. SUITE 20
SAN JOSE CA
95117-1597
US

V. Phone/Fax

Practice location:
  • Phone: 408-615-1516
  • Fax: 866-754-1516
Mailing address:
  • Phone: 408-615-1516
  • Fax: 866-754-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26728
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT26728
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT26728
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT26728
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT26728
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: GRETCHEN A LEACHMAN
Title or Position: OWNER/CEO
Credential: DPT
Phone: 408-615-1516