MEDICARE: BONNIE JO GALLOP P.T.

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	PT3058	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3058	OTHER	OK	P.T. LICENSE

General Provider Information

NPI Number	:	1598875031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE JO GALLOP P.T.

Provider Business Mailing Address
First Line	:	3110 SW 89TH ST
Second Line	:	SUITE 200D
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7920
Country	:	US
Telephone Number	:	405-631-8888
Fax Number	:	405-631-9593

Provider Business Practice Location Address
First Line	:	3110 SW 89TH ST
Second Line	:	SUITE 200D
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7920
Country	:	US
Telephone Number	:	405-631-8888
Fax Number	:	405-631-9593

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/22/2009

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Directions to “ BONNIE JO GALLOP P.T.” Practice Location

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