Provider Demographics
NPI:1932542354
Name:GALLAHUE, VIRGINIA MARICE (PTA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARICE
Last Name:GALLAHUE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3446 HURSTBOURNE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6522
Mailing Address - Country:US
Mailing Address - Phone:502-548-7924
Mailing Address - Fax:
Practice Address - Street 1:4604 LOWE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1514
Practice Address - Country:US
Practice Address - Phone:502-403-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01392225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant