Provider Demographics
NPI:1063085140
Name:GALVIN, EILEEN MARY
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARY
Last Name:GALVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 ORION AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4918
Mailing Address - Country:US
Mailing Address - Phone:410-215-7153
Mailing Address - Fax:
Practice Address - Street 1:1517 TECHNOLOGY DR STE 101
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5985
Practice Address - Country:US
Practice Address - Phone:757-339-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0009001597225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist