Provider Demographics
NPI:1801835178
Name:GALLAGHER, THOMAS BERNARD (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BERNARD
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 OAKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-1931
Mailing Address - Country:US
Mailing Address - Phone:914-245-0582
Mailing Address - Fax:
Practice Address - Street 1:662 OAKSIDE RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-1931
Practice Address - Country:US
Practice Address - Phone:914-245-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017406225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ31T51Medicare ID - Type UnspecifiedPROVIDER NUMBER