Provider Demographics
NPI:1760554117
Name:GALLOWAY, AMY SMITH (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SMITH
Last Name:GALLOWAY
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 1:1101 GRACIE PL STE A
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2260
Mailing Address - Country:US
Mailing Address - Phone:919-734-9644
Mailing Address - Fax:919-429-8473
Practice Address - Street 1:1101 GRACIE PL STE A
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2260
Practice Address - Country:US
Practice Address - Phone:919-734-9644
Practice Address - Fax:919-429-8473
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist