Provider Demographics
NPI:1518234822
Name:GALLOWAY, SHEENA RAE LEE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:RAE LEE
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 ARAPAHO ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-7373
Mailing Address - Country:US
Mailing Address - Phone:541-777-0592
Mailing Address - Fax:
Practice Address - Street 1:5901 HIGHWAY 165 BYP
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-7236
Practice Address - Country:US
Practice Address - Phone:318-361-0467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2001732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer