Provider Demographics
NPI:1225302359
Name:GALLAGHER, MICHAEL W (PT,DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3284
Mailing Address - Country:US
Mailing Address - Phone:978-352-5510
Mailing Address - Fax:978-352-5530
Practice Address - Street 1:880 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3284
Practice Address - Country:US
Practice Address - Phone:978-352-5510
Practice Address - Fax:978-352-5530
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist