MEDICARE: KAITLIN E GALLEHER DPT

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	PT022929	PA

General Provider Information

NPI Number	:	1366874257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN E GALLEHER DPT

Provider Business Mailing Address
First Line	:	902 W ERIE PLZ
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4536
Country	:	US
Telephone Number	:	814-456-6000
Fax Number	:	814-456-6060

Provider Business Practice Location Address
First Line	:	4472 BUFFALO RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16510-2228
Country	:	US
Telephone Number	:	814-464-0660
Fax Number	:	814-464-0663

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	01/10/2019

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