Provider Demographics
NPI:1154461705
Name:BECKER-GALUSHA, JANE E (PT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:BECKER-GALUSHA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32921 DANAPOPLAR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3104
Mailing Address - Country:US
Mailing Address - Phone:360-631-6877
Mailing Address - Fax:
Practice Address - Street 1:4200 TRABUCO RD
Practice Address - Street 2:SUITE 150
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3600
Practice Address - Country:US
Practice Address - Phone:949-651-9199
Practice Address - Fax:949-651-6034
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8351025Medicaid
WAAB12607Medicare ID - Type Unspecified