MEDICARE: GALLIANT TX LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	251S00000X	Community/Behavioral Health Agency
4	261QD1600X	Developmental Disabilities Clinic/Center
5	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1578166567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALLIANT TX LLC

Provider Business Mailing Address
First Line	:	6105 YELLOW ROSE CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 YELLOW ROSE CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1657
Country	:	US
Telephone Number	:	972-777-1331
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANDREW HOLDER
Credential	:
Telephone Number	:	917-608-5519

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	03/20/2024

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Directions to “GALLIANT TX LLC ” Practice Location

Language	Start Address	Practice Location

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