Provider Demographics
NPI:1679801914
Name:GALLO PROSTHETIC & ORTHOTIC SOLUTIONS, LLC
Entity type:Organization
Organization Name:GALLO PROSTHETIC & ORTHOTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:941-493-4049
Mailing Address - Street 1:4130 WOODMERE PARK BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2206
Mailing Address - Country:US
Mailing Address - Phone:941-493-4049
Mailing Address - Fax:941-416-9216
Practice Address - Street 1:4130 WOODMERE PARK BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2206
Practice Address - Country:US
Practice Address - Phone:941-493-4049
Practice Address - Fax:941-416-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR - 014335E00000X
FLPOR - 006335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6426820001Medicare NSC