Provider Demographics
NPI:1194924183
Name:GALLAGHER REHAB AND WELLNESS,INC
Entity type:Organization
Organization Name:GALLAGHER REHAB AND WELLNESS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-785-2267
Mailing Address - Street 1:406 BUZZEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:ME
Mailing Address - Zip Code:04847-3511
Mailing Address - Country:US
Mailing Address - Phone:207-785-2267
Mailing Address - Fax:
Practice Address - Street 1:406 BUZZEL HILL RD
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:ME
Practice Address - Zip Code:04847-3511
Practice Address - Country:US
Practice Address - Phone:207-785-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0002150Medicare PIN