Provider Demographics
NPI:1174747232
Name:GALLAGHER, JAMES C (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:C
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 NW LEWISBURG AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9604
Mailing Address - Country:US
Mailing Address - Phone:541-745-3926
Mailing Address - Fax:
Practice Address - Street 1:840 NW LEWISBURG AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9604
Practice Address - Country:US
Practice Address - Phone:541-745-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist