Provider Demographics
NPI:1740287002
Name:GALLOWAY, TAMARA (PT)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:PT
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 32490
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-2490
Mailing Address - Country:US
Mailing Address - Phone:602-230-4478
Mailing Address - Fax:602-230-9962
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:STE 506
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2849
Practice Address - Country:US
Practice Address - Phone:602-253-6623
Practice Address - Fax:602-252-1723
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ781353Medicaid
AZZ80076Medicare PIN
AZ781353Medicaid