Healthcare Provider Details

I. General information

NPI: 1174297428
Provider Name (Legal Business Name): TODD JAMES GALLAGHER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 02/11/2022
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 BRANNAN WAY
WEST SACRAMENTO CA
95691-4539
US

IV. Provider business mailing address

2669 BRANNAN WAY
WEST SACRAMENTO CA
95691-4539
US

V. Phone/Fax

Practice location:
  • Phone: 530-220-3612
  • Fax:
Mailing address:
  • Phone: 530-220-3612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: