Provider Demographics
NPI:1912082629
Name:GALLAGHER, JENNIFER MARIE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:290 LARKFIELD RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2444
Mailing Address - Country:US
Mailing Address - Phone:631-547-5600
Mailing Address - Fax:631-427-2223
Practice Address - Street 1:290 LARKFIELD RD UNIT B
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2444
Practice Address - Country:US
Practice Address - Phone:631-547-5600
Practice Address - Fax:631-427-2223
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022826-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic