Provider Demographics
NPI:1841248911
Name:GALLAGHER, SARAH LOUISE (LMT)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LOUISE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:LOUISE
Other - Last Name:JOHANSEN-GALLAGHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:4060 SW 110TH AVE
Mailing Address - Street 2:CHIROPRACTIC LIFE CENTER
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3017
Mailing Address - Country:US
Mailing Address - Phone:503-644-4846
Mailing Address - Fax:503-644-0409
Practice Address - Street 1:12270 SW ASPEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-0713
Practice Address - Country:US
Practice Address - Phone:503-267-3716
Practice Address - Fax:503-644-0409
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10087OtherMASSAGE LICENSE