Provider Demographics
NPI:1598133027
Name:GALLO, CLINT WILLIAM (DPT)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:WILLIAM
Last Name:GALLO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3702
Mailing Address - Country:US
Mailing Address - Phone:985-732-1651
Mailing Address - Fax:985-241-5400
Practice Address - Street 1:414 AVENUE B
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3702
Practice Address - Country:US
Practice Address - Phone:985-732-1651
Practice Address - Fax:985-241-5400
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist