Provider Demographics
NPI:1528469939
Name:GALLEGLY, JAY RICHARD (MS, ATC/L)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:RICHARD
Last Name:GALLEGLY
Suffix:
Gender:M
Credentials:MS, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3911
Mailing Address - Country:US
Mailing Address - Phone:405-255-0136
Mailing Address - Fax:
Practice Address - Street 1:9500 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3911
Practice Address - Country:US
Practice Address - Phone:405-255-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer