Provider Demographics
NPI:1568461259
Name:GALLAGHER, RONALD J JR (PT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
Last Name:GALLAGHER
Suffix:JR
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 1:3602 E SUNSET RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-7202
Mailing Address - Country:US
Mailing Address - Phone:702-932-4308
Mailing Address - Fax:702-837-8930
Practice Address - Street 1:1681 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3494
Practice Address - Country:US
Practice Address - Phone:702-835-0165
Practice Address - Fax:702-835-0169
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504581Medicaid
NV100856Medicare PIN