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General NPI Number Information
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NPI Number | 1043529415
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Entity Type | Individual
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Provider Name | SAMANTHA J GALLUP PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 2-8 W MAIN ST
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City | JOHNSTOWN
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State | NY
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Zip | 12095-2308
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Country | US
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Telephone | 518-848-0843
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Fax |
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Provider Business Mailing Address
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Address Line | 9 EUCLID AVE
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City | BALLSTON SPA
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State | NY
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Zip | 12020-3628
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Country | US
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Telephone | 518-848-2709
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 031940
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License Number State | NY
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