Provider Demographics
NPI:1548244320
Name:GALVER, JOHNNY W (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:W
Last Name:GALVER
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 1:233 MADRONA AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4609
Mailing Address - Country:US
Mailing Address - Phone:503-566-7782
Mailing Address - Fax:503-566-7783
Practice Address - Street 1:233 MADRONA AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4609
Practice Address - Country:US
Practice Address - Phone:503-566-7782
Practice Address - Fax:503-566-7783
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR158261Medicaid
OR158261Medicaid