Provider Demographics
NPI:1659197978
Name:GALLMAN, AVERY (MED, LPATA, ATR-P)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:GALLMAN
Suffix:
Gender:F
Credentials:MED, LPATA, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-6615
Mailing Address - Country:US
Mailing Address - Phone:502-430-9956
Mailing Address - Fax:
Practice Address - Street 1:13011 W HIGHWAY 42 STE 207
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7156
Practice Address - Country:US
Practice Address - Phone:502-694-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288313221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist