Healthcare Provider Details

I. General information

NPI: 1104137207
Provider Name (Legal Business Name): TERESA GALLO-THYS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA GALLO D.O.

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S CONGRESS AVE STE 105
BOYNTON BEACH FL
33426-7400
US

IV. Provider business mailing address

6615 W BOYNTON BEACH BLVD STE 412
BOYNTON BEACH FL
33437-3526
US

V. Phone/Fax

Practice location:
  • Phone: 561-203-5282
  • Fax: 740-212-8513
Mailing address:
  • Phone: 561-882-4541
  • Fax: 561-650-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-7902
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS13449
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS13449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: