Provider Demographics
NPI:1003363474
Name:GALLO, PAUL M (EDD,, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:GALLO
Suffix:
Gender:M
Credentials:EDD,, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 RICHARDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1634
Mailing Address - Country:US
Mailing Address - Phone:203-857-7194
Mailing Address - Fax:203-857-7098
Practice Address - Street 1:188 RICHARDS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-1634
Practice Address - Country:US
Practice Address - Phone:203-857-7194
Practice Address - Fax:203-857-7098
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0007852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer