Provider Demographics
NPI:1104156751
Name:GALLAGHER, MEGAN DEDRA (MSED, ATC, VATL)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:DEDRA
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MSED, ATC, VATL
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3611 GATEWAY DR APT 2D
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5016
Mailing Address - Country:US
Mailing Address - Phone:757-613-1388
Mailing Address - Fax:
Practice Address - Street 1:4301 CEDAR LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2074
Practice Address - Country:US
Practice Address - Phone:757-613-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260011432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer