Provider Demographics
NPI:1538248471
Name:GALLAGHER, CHARLES EDWARD (PT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWARD
Last Name:GALLAGHER
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 1:11402 N NEWPORT HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1616
Mailing Address - Country:US
Mailing Address - Phone:509-464-1813
Mailing Address - Fax:509-464-4813
Practice Address - Street 1:11402 N NEWPORT HWY
Practice Address - Street 2:SUITE B
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1616
Practice Address - Country:US
Practice Address - Phone:509-464-1813
Practice Address - Fax:509-464-4813
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7102288Medicaid
WAS97626Medicare UPIN
WA7102288Medicaid