Healthcare Provider Details

I. General information

NPI: 1811815426
Provider Name (Legal Business Name): ERIC A GALLY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W COLORADO AVE STE B-204
COLORADO SPRINGS CO
80904-3863
US

IV. Provider business mailing address

2808 BOXWOOD PL
COLORADO SPRINGS CO
80920-4019
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-1669
  • Fax:
Mailing address:
  • Phone: 719-433-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT0013947
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: