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General NPI Number Information
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NPI Number | 1659509503
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Entity Type | Individual
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Provider Name | KATHLEEN LINDA GALLEN LMT
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Gender | Female
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 2722 MANATEE AVE W SUITE #1
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City | BRADENTON
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State | FL
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Zip | 34205-4945
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Country | US
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Telephone | 941-713-1637
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Fax |
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Provider Business Mailing Address
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Address Line | 3203 AVENUE A W
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City | BRADENTON
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State | FL
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Zip | 34205-3425
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Country | US
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Telephone | 941-713-1637
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA50564
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License Number State | FL
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