1184816449 NPI number — KAREN GALLO PT, DPT, CLT

Table of content: ALEXANDRIA STORMANN P.A. (NPI 1689922130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184816449 NPI number — KAREN GALLO PT, DPT, CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLO
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, CLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUGH
Provider Other First Name:
KAREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184816449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 DOCK HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17842-8910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-837-2123
Provider Business Mailing Address Fax Number:
570-837-2185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
248 GRANITE RUN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-6804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-560-2917
Provider Business Practice Location Address Fax Number:
717-560-2985
Provider Enumeration Date:
08/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT009738L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1028140200001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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