Provider Demographics
NPI:1447676820
Name:GALLOWAY THERAPY SERVICES, INC
Entity type:Organization
Organization Name:GALLOWAY THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-934-6454
Mailing Address - Street 1:946 NE 96TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2524
Mailing Address - Country:US
Mailing Address - Phone:305-934-6454
Mailing Address - Fax:305-756-9527
Practice Address - Street 1:9280 HAMMOCKS BLVD
Practice Address - Street 2:106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1507
Practice Address - Country:US
Practice Address - Phone:305-383-3348
Practice Address - Fax:305-756-9527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10-3247261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004696000Medicaid