Provider Demographics
NPI:1598875031
Name:GALLOP, BONNIE JO (PT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JO
Last Name:GALLOP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:JO
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3110 SW 89TH ST
Mailing Address - Street 2:SUITE 200D
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7920
Mailing Address - Country:US
Mailing Address - Phone:405-631-8888
Mailing Address - Fax:405-631-9593
Practice Address - Street 1:3110 SW 89TH ST
Practice Address - Street 2:SUITE 200D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7920
Practice Address - Country:US
Practice Address - Phone:405-631-8888
Practice Address - Fax:405-631-9593
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT3058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3058OtherP.T. LICENSE