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General NPI Number Information
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NPI Number | 1548642010
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Entity Type | Individual
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Provider Name | STEPHEN GALVAN
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Gender | Male
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 500 E VETERANS WAY
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City | TEMPE
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State | AZ
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Zip | 85287-0001
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Country | US
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Telephone | 956-579-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 128 HIGHLAND TER
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City | BROWNSVILLE
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State | TX
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Zip | 78521-5614
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1221
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License Number State | AZ
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