Provider Demographics
NPI:1578517561
Name:GALLUP, DEBBY JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBBY
Middle Name:JANE
Last Name:GALLUP
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 1:24242 LA CRESTA DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2561
Mailing Address - Country:US
Mailing Address - Phone:949-496-3363
Mailing Address - Fax:949-489-3752
Practice Address - Street 1:24242 LA CRESTA DR
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2561
Practice Address - Country:US
Practice Address - Phone:949-496-3363
Practice Address - Fax:949-489-3752
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8416225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics