Provider Demographics
NPI:1629117841
Name:GALLAGHER-BRADLEY, UNA M
Entity Type:Individual
Prefix:
First Name:UNA
Middle Name:M
Last Name:GALLAGHER-BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:UNA
Other - Middle Name:M
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, PT
Mailing Address - Street 1:82 WINTERCRESS LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4713
Mailing Address - Country:US
Mailing Address - Phone:631-266-1499
Mailing Address - Fax:
Practice Address - Street 1:82 WINTERCRESS LN
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4713
Practice Address - Country:US
Practice Address - Phone:631-266-5993
Practice Address - Fax:631-266-5993
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400068279Medicare PIN