Provider Demographics
NPI:1760518955
Name:GALEGHER, CONSTANCE LOUISE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:LOUISE
Last Name:GALEGHER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 HEMPHILL DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-4710
Mailing Address - Country:US
Mailing Address - Phone:360-491-5819
Mailing Address - Fax:
Practice Address - Street 1:2716 PACIFIC AVE SE
Practice Address - Street 2:SUITE D
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-8803
Practice Address - Country:US
Practice Address - Phone:360-705-4403
Practice Address - Fax:360-705-0964
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA6657225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist