Provider Demographics
NPI:1003038266
Name:CHARLES GALLAGHER PT, PS
Entity Type:Organization
Organization Name:CHARLES GALLAGHER PT, PS
Other - Org Name:THE INSTITUTE FOR PHYSICAL AND SPORS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-464-1813
Mailing Address - Street 1:11402 N NEWPORT HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1616
Mailing Address - Country:US
Mailing Address - Phone:509-464-1813
Mailing Address - Fax:509-464-4813
Practice Address - Street 1:11402 N NEWPORT HWY
Practice Address - Street 2:SUITE B
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1616
Practice Address - Country:US
Practice Address - Phone:509-464-1813
Practice Address - Fax:509-464-4813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007501261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7102288Medicaid
WA7102288Medicaid
WAS97626Medicare UPIN