Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 6637 | OH |
NPI | 1700827987 |
---|---|
Provider Name | Sean P Gallivan |
First Address | Xenia, OH 45385-9329 |
Second Address | Dayton, OH 45409-2722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 08/07/2007 |