Provider Demographics
NPI:1205412202
Name:GALLO, LINDSAY NICOLE
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:NICOLE
Last Name:GALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 MUSKEGON WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5778
Mailing Address - Country:US
Mailing Address - Phone:561-346-5683
Mailing Address - Fax:
Practice Address - Street 1:2055 E GEORGIA ST
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-6710
Practice Address - Country:US
Practice Address - Phone:863-533-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20355208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation