Provider Demographics
NPI:1750421749
Name:GALLION, KELLEEN A (PT)
Entity type:Individual
Prefix:
First Name:KELLEEN
Middle Name:A
Last Name:GALLION
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:GALLION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:7215 N VIA DE PAESIA
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3739
Mailing Address - Country:US
Mailing Address - Phone:480-607-1716
Mailing Address - Fax:
Practice Address - Street 1:7215 N VIA DE PAESIA
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3739
Practice Address - Country:US
Practice Address - Phone:480-607-1716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist