Provider Demographics
NPI:1538129812
Name:GALLOWAY, JOHN CARLDON (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CARLDON
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2648
Mailing Address - Country:US
Mailing Address - Phone:501-319-7659
Mailing Address - Fax:501-353-2781
Practice Address - Street 1:4624 E 43RD ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2648
Practice Address - Country:US
Practice Address - Phone:501-319-7659
Practice Address - Fax:501-353-2781
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W483OtherBLUE CROSS AND BLUE SHIEL
AR142174721Medicaid
AR5W483OtherBLUE CROSS AND BLUE SHIEL