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General NPI Number Information
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NPI Number | 1730098278
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Entity Type | Organization
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Legal Business Name | ROADRUNNER PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 1300 W MALONEY AVE STE 140
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City | GALLUP
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State | NM
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Zip | 87301-3313
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Country | US
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Telephone | 505-397-7560
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Fax |
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Provider Business Mailing Address
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Address Line | 3718 MAYA DR
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City | GALLUP
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State | NM
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Zip | 87301-4561
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Country | US
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Telephone | 505-397-7560
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAWEL GREDECKI
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Credential |
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Telephone | 505-397-7560
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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 |
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License Number State |
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