Provider Demographics
NPI:1306166020
Name:GALLAGHER, ROBERT JR (ATC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:GALLAGHER
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 SABAL SPRINGS CIR
Mailing Address - Street 2:#204
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2675 SABAL SPRINGS CIR
Practice Address - Street 2:#204
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3155
Practice Address - Country:US
Practice Address - Phone:727-804-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer