Provider Demographics
NPI:1477967651
Name:GALLAGHER, LISA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
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 1:16600 W SPRAGUE RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6318
Mailing Address - Country:US
Mailing Address - Phone:216-820-4490
Mailing Address - Fax:866-848-2496
Practice Address - Street 1:16600 W SPRAGUE RD
Practice Address - Street 2:SUITE 365
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-6318
Practice Address - Country:US
Practice Address - Phone:216-820-4490
Practice Address - Fax:866-848-2496
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH014764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist