Provider Demographics
NPI:1609972835
Name:GALLOWAY, JEFFREY ALLEN (MPT, OTR/L,MTC,CHT,C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLEN
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:MPT, OTR/L,MTC,CHT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 PAVILION CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6665
Mailing Address - Country:US
Mailing Address - Phone:678-432-4621
Mailing Address - Fax:678-583-1274
Practice Address - Street 1:908 PAVILION CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6665
Practice Address - Country:US
Practice Address - Phone:678-432-4621
Practice Address - Fax:678-583-1274
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCTRMedicare PIN
GAGRP6919Medicare PIN