Healthcare Provider Details

I. General information

NPI: 1942937230
Provider Name (Legal Business Name): EMILY GALLAGHER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY BEAN

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S MAIN
CEDAR SPRINGS MI
49319-8925
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 616-696-6555
  • Fax: 616-965-2475
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302096
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: