Active NPI
Audrey Galloway, PTA
- Physical Therapy Assistant
- Phoenix, AZ
National Provider Identifier
1174090963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 013809
- Practice address
- 1300 N 12TH St Ste 506
Phoenix, AZ 85006-2849 - Phone
- (602) 253-6623
- Fax
- (602) 252-1723
- NPI assigned
- Oct 30, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 013809 | AZ | Primary |
Addresses
Primary practice location
1300 N 12TH St Ste 506
Phoenix, AZ 85006-2849
Mailing address
1300 N 12TH St Ste 506
Phoenix, AZ 85006-2849
Phone (602) 253-6623
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 013809 | Other | AZ | PTA LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013809 | AZ | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540857600000",
"number": "1174090963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 N 12TH ST STE 506",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062849",
"telephone_number": "602-253-6623",
"fax_number": "602-252-1723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 N 12TH ST STE 506",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062849",
"telephone_number": "602-253-6623",
"fax_number": "602-252-1723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLOWAY",
"first_name": "AUDREY",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-30",
"last_updated": "2018-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AZ",
"license": "013809",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA LICENSE",
"identifier": "013809",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.