Healthcare Provider Details

I. General information

NPI: 1033780010
Provider Name (Legal Business Name): RACHEL GALLAWAY MA, AT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E MICHIGAN AVE
JACKSON MI
49201-1852
US

IV. Provider business mailing address

1201 E MICHIGAN AVE
JACKSON MI
49201-1852
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number2601002410
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: