Jeff Gallichan, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA8658 Issued in FL

Practice address

255 E Main St
Lake Alfred, FL 33850-2133

Phone

(727) 803-1102

NPI assigned

Aug 12, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1841846300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 1ST AVE S STE 200",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337014364",
            "telephone_number": "727-803-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E MAIN ST",
            "city": "LAKE ALFRED",
            "state": "FL",
            "postal_code": "338502133",
            "telephone_number": "727-803-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLICHAN",
        "first_name": "JEFF",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-12",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA8658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Lake Alfred, FL
• Providers in Lake Alfred, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.