Provider Demographics
NPI:1588045470
Name:GALLINERO, JOHNALYN
Entity Type:Individual
Prefix:
First Name:JOHNALYN
Middle Name:
Last Name:GALLINERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W 40TH AVE
Mailing Address - Street 2:APARTMENT 24
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6939
Mailing Address - Country:US
Mailing Address - Phone:870-535-0010
Mailing Address - Fax:870-535-1116
Practice Address - Street 1:6810 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7828
Practice Address - Country:US
Practice Address - Phone:870-535-0010
Practice Address - Fax:870-535-1116
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32192251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics