Provider Demographics
NPI:1154346120
Name:MCINTOSH, GALE WELLS (PT)
Entity type:Individual
Prefix:MS
First Name:GALE
Middle Name:WELLS
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3587
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-3587
Mailing Address - Country:US
Mailing Address - Phone:650-560-8043
Mailing Address - Fax:650-897-8335
Practice Address - Street 1:300 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019
Practice Address - Country:US
Practice Address - Phone:650-560-8043
Practice Address - Fax:650-897-8335
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14501225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88539Medicare UPIN
CA0PT145010Medicare ID - Type Unspecified