Provider Demographics
NPI:1356485528
Name:GALLOWAY, VALERIE LYNNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:LYNNE
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5622 SNOWY ORCHID DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7637
Mailing Address - Country:US
Mailing Address - Phone:678-432-4621
Mailing Address - Fax:678-583-1274
Practice Address - Street 1:908 PAVILION CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6665
Practice Address - Country:US
Practice Address - Phone:678-432-4621
Practice Address - Fax:678-583-1274
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001332225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCTRMedicare PIN
GAGRP6919Medicare PIN