Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 6184 | SC |
Y | 2251S0007X | Physical Therapist - Sports | 11712 | CO |
NPI | 1154632628 |
---|---|
Provider Name | Philip Brent Galloway |
First Address | Vail, CO 81658-7520 |
Second Address | Vail, CO 81657-5242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 10/12/2021 |