Provider Demographics
NPI:1033149869
Name:GALLOWAY, LEONARD MERLIN (MPT)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:MERLIN
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 KERN WAY
Mailing Address - Street 2:STE 102
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7804
Mailing Address - Country:US
Mailing Address - Phone:760-322-5090
Mailing Address - Fax:760-322-9175
Practice Address - Street 1:27620 LANDAU BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5540
Practice Address - Country:US
Practice Address - Phone:760-322-5090
Practice Address - Fax:760-322-9175
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT201230Medicare PIN
CAP00280112Medicare PIN