Provider Demographics
NPI:1073839064
Name:GALLOWAY, MADELENE
Entity Type:Individual
Prefix:
First Name:MADELENE
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 PLANTATION DR STE 160
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5040
Mailing Address - Country:US
Mailing Address - Phone:832-595-6001
Mailing Address - Fax:832-595-6003
Practice Address - Street 1:815 PLANTATION DR STE 160
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5040
Practice Address - Country:US
Practice Address - Phone:832-595-6001
Practice Address - Fax:832-595-6003
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107815173C00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist