Healthcare Provider Details

I. General information

NPI: 1558591529
Provider Name (Legal Business Name): ALEGRE GALLEGOS MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HARPER DR NE STE 110
ALBUQUERQUE NM
87109-3573
US

IV. Provider business mailing address

5700 HARPER DR NE STE 110
ALBUQUERQUE NM
87109-3573
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-9166
  • Fax: 505-858-0030
Mailing address:
  • Phone: 505-823-9166
  • Fax: 505-858-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3721
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: