Healthcare Provider Details

I. General information

NPI: 1730258724
Provider Name (Legal Business Name): ELIAS LOPEZ GALVAN JR. P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 FORTVIEW RD SUITE 109
AUSTIN TX
78704-7657
US

IV. Provider business mailing address

3109 JONES RD
SUNSET VALLEY TX
78745-1334
US

V. Phone/Fax

Practice location:
  • Phone: 512-892-5250
  • Fax: 512-892-7183
Mailing address:
  • Phone: 512-671-0726
  • Fax: 512-892-7183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1148279
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1148279
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: