Provider Demographics
NPI:1881768869
Name:GALLIEN INC
Entity type:Organization
Organization Name:GALLIEN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:505-437-1967
Mailing Address - Street 1:1809 INDIAN WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4617
Mailing Address - Country:US
Mailing Address - Phone:575-437-1967
Mailing Address - Fax:575-437-3969
Practice Address - Street 1:1809 INDIAN WELLS RD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4617
Practice Address - Country:US
Practice Address - Phone:575-437-1967
Practice Address - Fax:575-437-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM18042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM400521174Medicare ID - Type UnspecifiedPHYSICAL THERAPIST
NM400521174Medicare UPIN