Provider Demographics
NPI:1558968792
Name:GALLO, KATRINA TRINIDAD (ATC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:TRINIDAD
Last Name:GALLO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:JAVIER
Other - Last Name:TRINIDAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:400 CLARICE AVE APT 175
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2635
Mailing Address - Country:US
Mailing Address - Phone:818-448-5473
Mailing Address - Fax:
Practice Address - Street 1:9201 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28223-0001
Practice Address - Country:US
Practice Address - Phone:704-687-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer