Basic Information
| Provider Information | |||||||||
| NPI: | 1659699940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALGON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | ROEHRS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25608 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841250608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063204476 | ||||||||
| FaxNumber: | 2065687043 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 NE BLAKELY DR | ||||||||
| Address2: | STE 4020 | ||||||||
| City: | ISSAQUAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980296201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254982272 | ||||||||
| FaxNumber: | 4254982334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2010 | ||||||||
| LastUpdateDate: | 02/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | OP60612324 | WA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | OS016469 | PA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.