Provider Demographics
NPI:1871249839
Name:GALLAGHER, KIMBERLY RACHEL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RACHEL
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2562
Mailing Address - Country:US
Mailing Address - Phone:415-258-9894
Mailing Address - Fax:
Practice Address - Street 1:801 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-2562
Practice Address - Country:US
Practice Address - Phone:415-258-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1355341225100000X
CA306347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist