Provider Demographics
NPI:1962843649
Name:GALLATIN, ANGELA (DPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GALLATIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14094 N PRISTINE CIR
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-6013
Mailing Address - Country:US
Mailing Address - Phone:208-691-8011
Mailing Address - Fax:
Practice Address - Street 1:14775 N KIMO CT STE A
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-8762
Practice Address - Country:US
Practice Address - Phone:208-687-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT- 3795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist