Provider Demographics
NPI:1750096590
Name:GALLENBERG, DEBRA SUE (LMT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:GALLENBERG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W10250 COUNTY ROAD K
Mailing Address - Street 2:
Mailing Address - City:ELCHO
Mailing Address - State:WI
Mailing Address - Zip Code:54428-9719
Mailing Address - Country:US
Mailing Address - Phone:715-275-3228
Mailing Address - Fax:
Practice Address - Street 1:N11228 ANTIGO STREET
Practice Address - Street 2:
Practice Address - City:ELCHO
Practice Address - State:WI
Practice Address - Zip Code:54428
Practice Address - Country:US
Practice Address - Phone:715-610-7835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15739-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist