MEDICARE: MARY GALLAGHER 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	PT 17433	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT 17433	OTHER	CA	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1639162423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GALLAGHER P.T.

Provider Business Mailing Address
First Line	:	1422 MONTEREY ST
Second Line	:	SUITE C-102
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2944
Country	:	US
Telephone Number	:	805-543-5100
Fax Number	:	805-543-5106

Provider Business Practice Location Address
First Line	:	1422 MONTEREY ST
Second Line	:	SUITE C-102
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2944
Country	:	US
Telephone Number	:	805-543-5100
Fax Number	:	805-543-5106

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	09/10/2013

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Directions to “ MARY GALLAGHER P.T.” Practice Location

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