Provider Demographics
NPI:1871025346
Name:GALIAS, RICHARD OLIVER (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD OLIVER
Middle Name:
Last Name:GALIAS
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 1:12417 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-3005
Mailing Address - Country:US
Mailing Address - Phone:815-608-9948
Mailing Address - Fax:
Practice Address - Street 1:129 COMMERCIAL DR
Practice Address - Street 2:#5B
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-4729
Practice Address - Country:US
Practice Address - Phone:630-553-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist