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General NPI Number Information
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NPI Number | 1811481369
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Entity Type | Individual
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Provider Name | HAILEY BETH WILSON GALLIVAN LMT
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Gender | Female
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 800 ROSE STREET 3RD FLOOR WHITNEY HENDRICKSON
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City | LEXINGTON
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State | KY
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Zip | 40536-0098
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Country | US
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Telephone | 859-323-4325
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Fax | 859-257-0661
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Provider Business Mailing Address
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Address Line | 2000 PLANTERS CT
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City | LEXINGTON
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State | KY
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Zip | 40514-5916
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Country | US
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Telephone | 859-333-0833
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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 | 107228
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License Number State | KY
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