Healthcare Provider Details

I. General information

NPI: 1780793422
Provider Name (Legal Business Name): SCOTT D GALLANT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CONCORD PLAZA
SAINT LOUIS MO
63128
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-2990
  • Fax: 314-842-5162
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number119753
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: