Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1245624816 |
---|---|
Provider Name | Mrs. Jenae Alexis Gallina |
First Address | Johnstown, PA 15904-3402 |
Second Address | Johnstown, PA 15904-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2015 |
Last Update Date | 22/03/2015 |