Provider Demographics
NPI:1174297428
Name:GALLAGHER, TODD JAMES (DPT)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:JAMES
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 1:2669 BRANNAN WAY
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-4539
Mailing Address - Country:US
Mailing Address - Phone:530-220-3612
Mailing Address - Fax:
Practice Address - Street 1:2669 BRANNAN WAY
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4539
Practice Address - Country:US
Practice Address - Phone:530-220-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist