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General NPI Number Information
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NPI Number | 1730554148
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Entity Type | Individual
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Provider Name | SIDNEY GALLARDO
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Gender | Female
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 1011A 10TH ST
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6425
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Country | US
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Telephone | 575-439-9878
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Fax | 575-439-9876
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Provider Business Mailing Address
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Address Line | 1011A 10TH STREET
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City | ALAMOGORDO
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State | NM
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Zip | 88310-4011
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Country | US
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Telephone | 575-439-9878
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Fax | 575-439-9876
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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 | A186
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License Number State | NM
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