MEDICARE: KAITLYN GALLOWAY DPT

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	2305215722	VA

General Provider Information

NPI Number	:	1841986635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN GALLOWAY DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 GUMWOOD DR
Second Line	:
City	:	SMITHFIELD
State	:	VA
Zip	:	23430-6087
Country	:	US
Telephone Number	:	757-357-7762
Fax Number	:

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

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	03/03/2026

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