=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386286409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN LYNN GALLOWAY PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2019
-----------------------------------------------------
Last Update Date | 10/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7685 BEECHMONT AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-231-2700
-----------------------------------------------------
Fax | 512-231-2666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8625 TORONTO CT
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255-3260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-714-5119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT009753
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------