Provider Demographics
NPI:1386035061
Name:GALLAGHER, CRYATAL (PTA)
Entity Type:Individual
Prefix:
First Name:CRYATAL
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-6226
Mailing Address - Country:US
Mailing Address - Phone:432-296-2538
Mailing Address - Fax:
Practice Address - Street 1:3311 THOMAS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-6226
Practice Address - Country:US
Practice Address - Phone:432-296-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2021036174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174V00000XOther Service ProvidersClinical Ethicist