MEDICARE: MS. TAMARA 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	649	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740287002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA GALLOWAY PT

Provider Business Mailing Address
First Line	:	PO BOX 32490
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85064-2490
Country	:	US
Telephone Number	:	602-230-4478
Fax Number	:	602-230-9962

Provider Business Practice Location Address
First Line	:	1300 N 12TH ST
Second Line	:	STE 506
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2849
Country	:	US
Telephone Number	:	602-253-6623
Fax Number	:	602-252-1723

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	10/15/2007

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