Provider Demographics
NPI:1578577433
Name:GALLOWAY THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:GALLOWAY THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:305-934-6454
Mailing Address - Street 1:9280 HAMMOCKS BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1507
Mailing Address - Country:US
Mailing Address - Phone:305-934-6454
Mailing Address - Fax:305-756-9527
Practice Address - Street 1:9280 HAMMOCKS BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1507
Practice Address - Country:US
Practice Address - Phone:305-934-6454
Practice Address - Fax:786-362-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004696000Medicaid
FL103247Medicare UPIN