Provider Demographics
NPI:1235205717
Name:GALLOWAY, KERRI ELIZABETH (MSPT)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:ELIZABETH
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:ELIZABETH
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2700 GREENUP AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1953
Mailing Address - Country:US
Mailing Address - Phone:606-324-0540
Mailing Address - Fax:606-324-0616
Practice Address - Street 1:711 S 3RD ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1854
Practice Address - Country:US
Practice Address - Phone:740-534-1156
Practice Address - Fax:740-534-1158
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT010725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2734321Medicaid
WV3810008282Medicaid
OH000000567576OtherANTHEM
WV3810008282Medicaid
OH000000567576OtherANTHEM