Healthcare Provider Details

I. General information

NPI: 1730098278
Provider Name (Legal Business Name): ROADRUNNER PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W MALONEY AVE STE 140
GALLUP NM
87301-3313
US

IV. Provider business mailing address

3718 MAYA DR
GALLUP NM
87301-4561
US

V. Phone/Fax

Practice location:
  • Phone: 505-397-7560
  • Fax:
Mailing address:
  • Phone: 505-397-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAWEL GREDECKI
Title or Position: OWNER
Credential:
Phone: 505-397-7560