Healthcare Provider Details

I. General information

NPI: 1336384338
Provider Name (Legal Business Name): MR. DANIEL EDWARD GALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S CHAMBERLAIN ST
ROSEVILLE IL
61473-9581
US

IV. Provider business mailing address

556 28TH AVE
EAST MOLINE IL
61244-3142
US

V. Phone/Fax

Practice location:
  • Phone: 309-426-2134
  • Fax:
Mailing address:
  • Phone: 309-737-1871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160003596
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: