Provider Demographics
NPI:1164638094
Name:GALLO, SALLY ANNE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ANNE
Last Name:GALLO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:SALLY
Other - Middle Name:ANNE
Other - Last Name:DARROCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1601 ZINFANDEL DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-7415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 HOPYARD RD
Practice Address - Street 2:SUITE 220
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3348
Practice Address - Country:US
Practice Address - Phone:925-730-0950
Practice Address - Fax:925-730-0960
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist