Provider Demographics
NPI:1679708523
Name:GALLAGHER, RYAN F (DPT, ATC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:F
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 MILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:CREIGHTON
Mailing Address - State:NE
Mailing Address - Zip Code:68729-3001
Mailing Address - Country:US
Mailing Address - Phone:402-668-2231
Mailing Address - Fax:
Practice Address - Street 1:405 JAMES ST
Practice Address - Street 2:
Practice Address - City:VERDIGRE
Practice Address - State:NE
Practice Address - Zip Code:68783-6149
Practice Address - Country:US
Practice Address - Phone:402-668-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist