=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861580722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRENCE P. GALVIN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 02/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 PALM BAY RD STE C
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32905-3851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-576-1233
-----------------------------------------------------
Fax | 321-327-5974
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 PALM BAY RD STE C
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32905-3851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-576-1233
-----------------------------------------------------
Fax | 321-327-5974
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | AS2676
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------