Healthcare Provider Details

I. General information

NPI: 1740455062
Provider Name (Legal Business Name): ALISON ELENA GALLUP P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON E RAKE

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 E COLORADO BLVD # 100
PASADENA CA
91107-3840
US

IV. Provider business mailing address

11410 JOLLYVILLE RD STE 1101
AUSTIN TX
78759-4093
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-3900
  • Fax: 626-449-4505
Mailing address:
  • Phone: 512-231-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1178240
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number35820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: