Healthcare Provider Details

I. General information

NPI: 1407761968
Provider Name (Legal Business Name): MICHELLE L GALLERY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 KNAPP ST NE
GRAND RAPIDS MI
49525-7006
US

IV. Provider business mailing address

2627 PINEVIEW DR NE
GRAND RAPIDS MI
49525-6707
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-1333
  • Fax: 616-447-2440
Mailing address:
  • Phone: 616-364-1333
  • Fax: 616-447-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010416
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: