Healthcare Provider Details

I. General information

NPI: 1548642010
Provider Name (Legal Business Name): STEPHEN GALVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 W 56TH ST
INDIANAPOLIS IN
46254-9698
US

IV. Provider business mailing address

128 HIGHLAND TER
BROWNSVILLE TX
78521-5614
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1221
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: