Provider Demographics
NPI:1891353322
Name:GALLAGHER, AILEEN M (PT)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:M
Last Name:GALLAGHER
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 1:36 WAYNE CT
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2342
Mailing Address - Country:US
Mailing Address - Phone:631-754-3764
Mailing Address - Fax:
Practice Address - Street 1:81 FORT SALONGA RD STE C
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2889
Practice Address - Country:US
Practice Address - Phone:631-380-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
012796-1225100000X
NY012796-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist