Provider Demographics
NPI:1558646083
Name:GALLEGLY, JEANIE D (RCEP)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:D
Last Name:GALLEGLY
Suffix:
Gender:F
Credentials:RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 E RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-6153
Mailing Address - Country:US
Mailing Address - Phone:903-531-9455
Mailing Address - Fax:903-526-3118
Practice Address - Street 1:1350 E RICHARDS ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-6153
Practice Address - Country:US
Practice Address - Phone:903-531-9455
Practice Address - Fax:903-526-3118
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX637848224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist