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General NPI Number Information
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NPI Number | 1417431321
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Entity Type | Individual
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Provider Name | LUIS EDUARDO GALLEGOS LPTA
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Gender | Male
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 1700 W GRIFFIN PKWY
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City | MISSION
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State | TX
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Zip | 78572-7305
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Country | US
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Telephone | 956-583-8876
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Fax | 956-580-2356
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Provider Business Mailing Address
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Address Line | 3306 NIKKIE LN
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City | EDINBURG
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State | TX
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Zip | 78542-8342
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Country | US
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Telephone | 956-402-0072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2058709
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License Number State | TX
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