MEDICARE: SHAWN PATRICK GALLAGHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5030	AZ

General Provider Information

NPI Number	:	1235568031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN PATRICK GALLAGHER

Provider Business Mailing Address
First Line	:	1643 N PLACITA DEL SOL CHIQUITO
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-5657
Country	:	US
Telephone Number	:	520-256-6391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1643 N PLACITA DEL SOL CHIQUITO
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-5657
Country	:	US
Telephone Number	:	520-256-6391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2013
Last Update Date	:	11/02/2013

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