Provider Demographics
NPI:1093025561
Name:GALLAHER, KIMBERLY ANN BECK (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN BECK
Last Name:GALLAHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6486 ARROYO DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8510
Mailing Address - Country:US
Mailing Address - Phone:321-591-1182
Mailing Address - Fax:321-351-2727
Practice Address - Street 1:417 5TH AVE APT 101B
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4224
Practice Address - Country:US
Practice Address - Phone:321-327-7889
Practice Address - Fax:321-372-3097
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist