Provider Demographics
NPI:1659509503
Name:GALLEN, KATHLEEN LINDA (LMT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LINDA
Last Name:GALLEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 AVENUE A W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-3425
Mailing Address - Country:US
Mailing Address - Phone:941-713-1637
Mailing Address - Fax:
Practice Address - Street 1:2722 MANATEE AVE W
Practice Address - Street 2:SUITE #1
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4945
Practice Address - Country:US
Practice Address - Phone:941-713-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist