MEDICARE: JOHN CARLDON GALLOWAY PT

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	PT2501	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5W483	OTHER	AR	BLUE CROSS AND BLUE SHIEL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538129812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CARLDON GALLOWAY PT

Provider Business Mailing Address
First Line	:	4624 E 43RD ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2648
Country	:	US
Telephone Number	:	501-319-7659
Fax Number	:	501-353-2781

Provider Business Practice Location Address
First Line	:	4624 E 43RD ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2648
Country	:	US
Telephone Number	:	501-319-7659
Fax Number	:	501-353-2781

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/03/2019

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