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General NPI Number Information
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NPI Number | 1750693768
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Entity Type | Individual
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Provider Name | ALWYN BALTAZAR GALELA BSN-RN
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Gender | Male
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 08/24/2017
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Provider Practice Location Address
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Address Line | 255 WHITE TAIL RUN
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City | CORTLAND
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State | OH
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Zip | 44410-2611
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Country | US
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Telephone | 330-646-7833
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Fax |
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Provider Business Mailing Address
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Address Line | 255 WHITETAIL RUN
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City | CORTLAND
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State | OH
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Zip | 44410
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Country | US
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Telephone | 330-646-7833
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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 | 0441
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.379594
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License Number State | OH
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