Provider Demographics
NPI:1558443184
Name:GALLERANI, MICHELLE (MS,PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:GALLERANI
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MAJESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,PT
Mailing Address - Street 1:47 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1926
Mailing Address - Country:US
Mailing Address - Phone:860-409-4595
Mailing Address - Fax:860-409-4860
Practice Address - Street 1:635 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2543
Practice Address - Country:US
Practice Address - Phone:860-447-8558
Practice Address - Fax:860-447-4552
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080007364CT08OtherANTHEM BC BS
CT080007364CT09OtherANTHEM BC BS
DC080007364CT10OtherANTHEM BC BS
CT650001121Medicare PIN