Individual
MR. JEREMY R. GALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
3701 CARROLL RD, FORT WAYNE, IN 46818-9528
(260) 637-3161
Mailing address
229 BAROUCHE PL, FORT WAYNE, IN 46845-2110
(260) 740-1261
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
36001023A
IN
2255A2300X
Athletic Trainer
Primary
36001023A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36001023A
INDIANA ATHLETIC TRAINERS LICENSE
IN
Enumeration date
10/03/2005
Last updated
04/29/2026
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