MEDICARE: MS. KATHLEEN LINDA GALLEN LMT

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	225700000X	Massage Therapist	MA50564	FL

General Provider Information

NPI Number	:	1659509503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN LINDA GALLEN LMT

Provider Business Mailing Address
First Line	:	3203 AVENUE A W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-3425
Country	:	US
Telephone Number	:	941-713-1637
Fax Number	:

Provider Business Practice Location Address
First Line	:	2722 MANATEE AVE W
Second Line	:	SUITE #1
City	:	BRADENTON
State	:	FL
Zip	:	34205-4945
Country	:	US
Telephone Number	:	941-713-1637
Fax Number	:

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

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	05/06/2013

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