Provider Demographics
NPI:1235959172
Name:GALLOW, EARL DARRELL JR (CPT)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:DARRELL
Last Name:GALLOW
Suffix:JR
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18441 GERANIUM RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-3322
Mailing Address - Country:US
Mailing Address - Phone:719-505-0955
Mailing Address - Fax:
Practice Address - Street 1:19150 ACORN RD STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-3657
Practice Address - Country:US
Practice Address - Phone:239-267-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171400000X
CO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer