Provider Demographics
NPI:1891910386
Name:GALLAGHER, TRAVIS STEVEN (ATC)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:STEVEN
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 COUNTY LINE RD W
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7295
Mailing Address - Country:US
Mailing Address - Phone:614-355-6019
Mailing Address - Fax:
Practice Address - Street 1:584 COUNTY LINE RD W
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7295
Practice Address - Country:US
Practice Address - Phone:614-355-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT 13442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer