Provider Demographics
NPI:1205084134
Name:GALLIGAN, BETH ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:GALLIGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:GALLIGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:5 GARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5960
Mailing Address - Country:US
Mailing Address - Phone:301-609-4890
Mailing Address - Fax:301-609-4070
Practice Address - Street 1:5 GARRETT AVE
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5960
Practice Address - Country:US
Practice Address - Phone:301-609-4890
Practice Address - Fax:301-609-4070
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205610225100000X
MD23621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist