Provider Demographics
NPI:1629185533
Name:GALLIGAN, TERESA GERALYN (PT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:GERALYN
Last Name:GALLIGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 PLEASANT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-6055
Mailing Address - Country:US
Mailing Address - Phone:410-974-4461
Mailing Address - Fax:
Practice Address - Street 1:6300 WOODSIDE CT
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1098
Practice Address - Country:US
Practice Address - Phone:410-312-9000
Practice Address - Fax:410-312-9001
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist