Provider Demographics
NPI:1154173763
Name:GALLOWAY, ROBERT ROY (PTA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ROY
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 ERICSSON DR
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8498
Mailing Address - Country:US
Mailing Address - Phone:330-936-2540
Mailing Address - Fax:
Practice Address - Street 1:615 LATHAM LN
Practice Address - Street 2:
Practice Address - City:NEW FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:44319-4338
Practice Address - Country:US
Practice Address - Phone:330-644-3914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08645225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant