Provider Demographics
NPI:1801397773
Name:GALES SHORT, VERONICA LYNELLE
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:LYNELLE
Last Name:GALES SHORT
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 1:1324 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2701
Mailing Address - Country:US
Mailing Address - Phone:410-744-4014
Mailing Address - Fax:
Practice Address - Street 1:3110 GRACEFIELD RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1820
Practice Address - Country:US
Practice Address - Phone:301-572-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist