Healthcare Provider Details

I. General information

NPI: 1083534416
Provider Name (Legal Business Name): KATHERINE GALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 DAIRY RD
MELBOURNE FL
32904-4046
US

IV. Provider business mailing address

2175 JUDGE FRAN JAMIESON WAY APT 302
MELBOURNE FL
32940-6177
US

V. Phone/Fax

Practice location:
  • Phone: 321-413-3366
  • Fax:
Mailing address:
  • Phone: 863-370-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2827733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: