Provider Demographics
NPI:1316766405
Name:GALLAER, BRYAN A (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:A
Last Name:GALLAER
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 SUMMERFIELD GDNS
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6300
Mailing Address - Country:US
Mailing Address - Phone:203-727-4821
Mailing Address - Fax:
Practice Address - Street 1:1950 E FORT UNION BLVD # 2
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-6894
Practice Address - Country:US
Practice Address - Phone:801-943-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist