Provider Demographics
NPI:1720543440
Name:GALLOWAY, JULIA A
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18550 N TUCKER SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:STURGEON
Mailing Address - State:MO
Mailing Address - Zip Code:65284-9637
Mailing Address - Country:US
Mailing Address - Phone:573-682-7716
Mailing Address - Fax:
Practice Address - Street 1:18550 N TUCKER SCHOOL RD
Practice Address - Street 2:
Practice Address - City:STURGEON
Practice Address - State:MO
Practice Address - Zip Code:65284-9637
Practice Address - Country:US
Practice Address - Phone:573-682-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer