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General NPI Number Information
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NPI Number | 1336384338
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Entity Type | Individual
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Provider Name | MR. DANIEL EDWARD GALL
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Gender | Male
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Dates
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Enumeration Date | 12/05/2008
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Last Update Date | 12/05/2008
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Provider Practice Location Address
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Address Line | 145 S CHAMBERLAIN ST
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City | ROSEVILLE
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State | IL
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Zip | 61473-9581
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Country | US
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Telephone | 309-426-2134
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Fax |
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Provider Business Mailing Address
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Address Line | 556 28TH AVE
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City | EAST MOLINE
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State | IL
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Zip | 61244-3142
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Country | US
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Telephone | 309-737-1871
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160003596
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License Number State |
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