Provider Demographics
NPI:1568706836
Name:GALLO, PATRICIA (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GALLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 AMES ST
Mailing Address - Street 2:
Mailing Address - City:ELK RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49629-9739
Mailing Address - Country:US
Mailing Address - Phone:231-264-6682
Mailing Address - Fax:231-264-9188
Practice Address - Street 1:128 AMES ST
Practice Address - Street 2:
Practice Address - City:ELK RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49629
Practice Address - Country:US
Practice Address - Phone:231-264-6682
Practice Address - Fax:231-264-9188
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015432225100000X
MI5501018994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018706580004Medicaid
PA271413R9XMedicare PIN