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General NPI Number Information
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NPI Number | 1437824745
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Entity Type | Individual
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Provider Name | STEPHEN R GALLEGOS
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Gender | Male
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 4299 A1A S
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-7421
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Country | US
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Telephone | 904-679-3449
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Fax |
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Provider Business Mailing Address
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Address Line | 113 SUNSET CIR S
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-5156
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Country | US
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Telephone | 505-231-7558
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2105
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT42251
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License Number State | FL
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