MEDICARE: MS. JULIE ANNE 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	01964	MO

General Provider Information

NPI Number	:	1932344496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE ANNE GALLAGHER P.T.

Provider Business Mailing Address
First Line	:	648 DOUGHERTY OAKS CT
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-5802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 S HANLEY RD
Second Line	:	SUITE 190
City	:	BRENTWOOD
State	:	MO
Zip	:	63144-1518
Country	:	US
Telephone Number	:	314-821-8304
Fax Number	:	800-327-1957

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

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	12/11/2008

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