Provider Demographics
NPI:1023995404
Name:GALLAGHER, BENJAMIN RAY (LMT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RAY
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20010 RIDGE RD SW
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-6266
Mailing Address - Country:US
Mailing Address - Phone:425-463-9158
Mailing Address - Fax:
Practice Address - Street 1:2702 1/2 N PROCTOR ST APT E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-5243
Practice Address - Country:US
Practice Address - Phone:425-463-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60943475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist