Provider Demographics
NPI:1508912627
Name:GALLAGHER, JENNIFER (MSPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MEETINGHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1002
Mailing Address - Country:US
Mailing Address - Phone:508-297-1696
Mailing Address - Fax:
Practice Address - Street 1:105 WASHINGTON ST
Practice Address - Street 2:SUITE 10
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1100
Practice Address - Country:US
Practice Address - Phone:508-238-5600
Practice Address - Fax:508-238-5600
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist