Healthcare Provider Details

I. General information

NPI: 1154671006
Provider Name (Legal Business Name): MARTHA GALLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W KAGY BLVD STE 2
BOZEMAN MT
59718-5938
US

IV. Provider business mailing address

27891 VIOLET
MISSION VIEJO CA
92691-6689
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-7873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: