Provider Demographics
NPI:1043689144
Name:GALLIEN, MEGAN BERRY (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BERRY
Last Name:GALLIEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MICHELLE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:534 MARCANTEL ROAD
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633
Mailing Address - Country:US
Mailing Address - Phone:337-884-2670
Mailing Address - Fax:
Practice Address - Street 1:534 MARCANTEL RD
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-5216
Practice Address - Country:US
Practice Address - Phone:337-884-2670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist