Provider Demographics
NPI:1083043301
Name:GALLAGHER, STEPHEN (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NORWOOD TER
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1710
Mailing Address - Country:US
Mailing Address - Phone:864-567-9435
Mailing Address - Fax:
Practice Address - Street 1:25 BOND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3401
Practice Address - Country:US
Practice Address - Phone:413-731-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0099677225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist