Provider Demographics
NPI:1295992964
Name:GALLAGHER, THERESA J (LMP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:J
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2203
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-2203
Mailing Address - Country:US
Mailing Address - Phone:253-797-1601
Mailing Address - Fax:
Practice Address - Street 1:28719 HWY 410 E
Practice Address - Street 2:SUITE 150
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-8799
Practice Address - Country:US
Practice Address - Phone:360-829-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018959225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist