Provider Demographics
NPI:1275622862
Name:GALT, STEPHEN A (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:GALT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-0610
Mailing Address - Country:US
Mailing Address - Phone:360-875-5543
Mailing Address - Fax:360-875-5544
Practice Address - Street 1:501 8TH ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3520
Practice Address - Country:US
Practice Address - Phone:360-532-0544
Practice Address - Fax:360-532-0559
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8382236Medicaid
WA8382236Medicaid
WAG8861756Medicare PIN