Provider Demographics
NPI:1386112357
Name:GALLEY, KRISTA PAIGE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:PAIGE
Last Name:GALLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:PAIGE
Other - Last Name:SYRACUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3925 SHERIDAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1738
Mailing Address - Country:US
Mailing Address - Phone:716-250-6500
Mailing Address - Fax:716-250-6555
Practice Address - Street 1:260 RED TAIL RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1562
Practice Address - Country:US
Practice Address - Phone:716-250-6551
Practice Address - Fax:716-250-6555
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist